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SSL SK SHIPS 241958944 � <br /> 4097 31 79zsfcs <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ' WASTE MANIFEST I CALOOD433477 1 1-000-468-1760 S KS <br /> 5.Genera tor's Name and Mailing Address Generator's Site Address if different than mailing address) <br /> S eedco Truck Lube and Tires - 944 <br /> 1° I IS Hoff Dr Huy 99 / 2379/Jackton <br /> RIPON CA 95366-0000 <br /> Generator's Phone 209-599-7961 <br /> E Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY-KLEEN.SYST£MS INC TXROODOO1205 <br /> ? 7ranspo-ter2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SERVICES INC HAD039322250 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLERK HARBORS GRASSY MOUNTAIN <br /> 3 MILES EAST, 7 MILES NORTH KNOLLS EXIT 41, OFF I-80 <br /> KNOLLS 'UT 84983 <br /> sPrkone 435-884-8915 UTD991301748 <br /> 5c kj S DOT Descnotron including Proper Shipping Name,Hazard Class.iD Number. 10.Containers 11.Total 12.Unit <br /> and Facxin,Grou;.:if any%: 13.Waste Codes <br /> No. Type Ouantly Wt.Nol. <br /> !"V,-NON RCRA HAZARDOUS WASTESOLIDS, �] DM P 352 <br /> 10 (OIL, DIRT AND SAND], L 306 <br /> W <br /> w 2 <br /> t� <br /> 3. <br /> a <br /> I <br /> j 'd Sfecia!Ha^.d.n,lnv Oior'sandAdditional Information <br /> TSDeGM 93778742 SP25842 CSG: <br /> 24HEMERGENCY#800-468-1760-CH/SK/TFI-Cgntract rgtained by generator confers a ency authori y <br /> i on nitial transporter to add or substitute additional transporters on generator's behalf. <br /> 15. GEN ERATO R'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and labeledlplacarded.and are in all respects in proper condition for transport according to applicable Intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,1 oer•ify that the contents of this censignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> l I eer.,L}that me waste minimization statement identified in 40 C F R 262.27(a)of I am a large quanfily generator)or(b)(if l am a small quantity generator)is true. <br /> Gener Offeror's Printed,Typed Name Sign Month Day Year <br /> 16.Intern-aTmal Shr of <br /> nts [I Import to U.S.F„ Export S. Port of enlrylexi! _ <br /> ? Transporter signature(for exportsordy): Dale leaving U.S.: <br /> 17.TransporterAcknowledgment of Receipt of Materials <br /> ua <br /> Transporter 1 Primed Typed Name Signature Month Day Year <br /> r ^'L s <br /> X Transporter 2 Pdnted+Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 8a D,svie arcy lncralion Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 185.Altemate Faci!iny;or Genera tcr1 U.S.EPA ID Number <br /> U <br /> r4i F a c Ii!y's Phone: <br /> '8; S:g^atu-o'Attemate Facility(or Generator) Month Day Year <br /> Lu <br /> a <br /> 7 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> A1 �� 2' 3• 4, <br /> 2C.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 1 Ba <br /> Prim 'P.%Na a Sign rice Month Day Year <br /> fyms editions are obsolete. DESIGNATED FACILITY TO EPA's -MANIFEST SYSTEM <br />