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SK SHIP#a�� IIIIIIIIIIIIIII�IIIIIIIIIIIIII VIII) <br /> 0 0 4 8 4 2 8 7 2 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number 2 Page 1 of 3.Emer Response Phone 4.Manf est Tracking Number <br /> UNIFORM HAZARDOUS CAL000c:26285 1 1—��-4ES— <br /> WASTE MANIFEST 1004842872 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Consolidated Container Co <br /> 75 W Valpico Rd <br /> Tracy CA 95376-9129 <br /> Generators Phone: 209-836-2151 <br /> r�spp��[L�pp�py��p�e� U.S.EPA ID Number <br /> 1.T fflff !jpip tN SYSTEMS, INC. TXR000081205 <br /> 7 Transporter 2 Company Name <br /> 0 r�S / U.S ID Number <br /> Tr-�� l —t8 1 L <br /> 8 Designated Facility Name and Site Address CLEAN HARBORS ARIZONA, LLC U.S.EPA to Number <br /> 1340 W LINCOLN ST <br /> PHX , f�Z [15007 07D049318009 <br /> 60c-258-6155 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Z. <br /> 1 NONE NDN RCRA HAZARDOUS WASTE SOLIDS, DM 1r <br /> o (ABSbRBENTS, RAGS, OIL), N/A I^ q 00 — <br /> � r✓ I <br /> Z 2. <br /> W <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD•PH 6761558 C099768 CSG <br /> 24 HR EMERGENCY #1-800-468-1760 (SAFETY—KLEEN) (�0oq?,-3� <br /> SK AUTHORIZED TO RETAIN LICENSED S <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 labeled/placarded.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 /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgement of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generaloes/Offeroes Pnnted/Typed Name Signature Month Day Year <br /> 0 7h#-A-e45 1--f � ry aao� L 1 S <br /> 16.International Shipments <br /> 11— ❑Import to U.S. Export from U.S. Port of <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> IX W 17.Transporter Acknowledgment of Receipt of Materials <br /> Tra iter 1 Phnted[Typed ame Signa Month Diay_ Year <br /> OMV I <br /> 11 f_ I l!7 <br /> rnU- h <br /> Z Transporter 2 Printed Typed Na SgOwl Month Day Year <br /> 1412.1-Z18 Discrepancy <br /> 18a.Discrepancy Indcation Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: Month Day Year <br /> LU 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> LU 1 2. 3 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest exci2t as noted in It 18a <br /> Print edhT d a e Signatu Mon pa <br /> EPgFo 8700-22 Rev.3-05) Previous edition are obsolete. D�SIGNQTED FACILITY TO ESTINATION STATE(IF REQUIRED) <br /> 1) 1�47337�/809842 <br />