Laserfiche WebLink
16 � <br /> _ II I II 1111111 I IIIIIlillll I!lilt II I NII <br /> SSL SK SHIP# �44E�_i6�+ �— <br /> 004a42873SKS <br /> Ple&3e print or type.(Form designed for use on elite(120tch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 13.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CALIVIO0226285 1-800-468-17601 1004842873 SKS <br /> 5,Generator's Name and Mating Address Generators Site Address Of different than mailing address) <br /> Consolidated Container CD <br /> 75 W Valpico Rd <br /> Tracy CA 95376-912 <br /> Generator's Phone: 209-836-2151 <br /> 6.Transporter t Company Nara U.S.EPA ID Number <br /> SAFETY—KLEEN SYSTEMS, INC. TXROOOOB1205 <br /> 7.Transporter 2 Company Name ` U.S.EPA 10 Number <br /> —�Q is a \ 1 Cl -73 <br /> 8.Designated Facility Name and Site Address CL AN HARBORS ARAGONITE LLC U.S.EPA ID Number <br /> 11600 NORTH--APTUS ROAD <br /> ARAGONITE r UT 84029 <br /> Facility's Phone: 435-884-8100 UTD981552'177 <br /> ga. 9b.U.S.DOT Description(Including Proper Upping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> Packing Group Of any)) 13.Waste Codes <br /> HM and Pad <br /> No. Type Quantity WiNol. <br /> X1. NA1993, WASTE COMBUSTIBLE LI¢UID DM P DOS D00 D008 <br /> N.0.S. , (OIL LEAD), COMBUfi. BLEB` �1 <br /> 4 LIQUID, PG I1I S 223 <br /> w <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD•AG 67615528 C099768 CSG <br /> s. 24EHR EME�tGENCY #1-800-468-1760 (SAI ETY—KLEEN) <br /> 15. GENERATOR'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 classified,packaged, <br /> marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Biporter,I certiN that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)Of I am a large quantity generator)or(b)Of I am a small quantity generator)is true. <br /> GerneratofsKMeror's Pdntedrryped Name Signature Month Day Year <br /> .o T��e /hy�t `7 11 rT- <br /> J <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of en <br /> Transporter signature(for exports ordy): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> d Tra r t Pngted/Typed me Signa Month Dayf� Year <br /> Q-, r r <br /> Z Transporter 2 Printed/Typed Name Sigriffire Month Day Year <br /> I 7 S <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection LJ Full Rejection <br /> Manifest Reference Number <br /> lab.Allernab Faclifty(or Gerwatar) U.S.EPA ID Number <br /> V <br /> Facility's Phone: <br /> 18c.Signature of AltemaW Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,oodes for hazardous waste treatment,disposal,and recycling systems) <br /> G ,. 2. 3. 4. <br /> 11 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnnte�ped Name Signature Month Day Year <br /> � � tl1� <br /> EP Foq)t 0�- Re.3-0'). P,2 ions editions are obsolete. DESIGN ED CILI TO DESTINATION STATE(IF REQUIRED) <br /> ) r ► 110c2�31 <br />