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SSL SK SHIP# 217468161 (1111111111111111111111111111111111111 <br /> 0 0 5 0 2 7 6 2 4 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 3� & Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emer enc Response Pho 4.Manifest Trackin <br /> WASTE MANIFEST CAL000226285 1 1-f�0N�-468-1760 10050M24 SKS <br /> 5.Generator's Name and Mailing Address Generator's SileAddress(if different than mailing address) <br /> Consolidated Container Co <br /> 75 W Valpico Rd <br /> TRACY CA 95376-9129 <br /> Generator's Phone: 209-836-8151 <br /> 6.Trans r 1 Company Name U.S.EPA ID Number <br /> S�FETY-KLEEN SYSTEMS, INC. TXR000031205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address CLEAN HARBORS ARIZONA, LLC U.S.EPA ID Number <br /> 1340 W LINCOLN ST <br /> PHX , AZ 85007 <br /> AZD049318O09 <br /> 602-258-6155 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> 1 NONE NON RCRA HAZARDOUS WASTE SOLIDS, DM P 2c3 <br /> o (ABSbRBENTS, RAGS, OIL), N/A ---i-- <br /> w <br /> Lob <br /> z 2. ` <br /> 3. <br /> 4 <br /> 14 Special Handling Instructions and Additional Information TSD:PH 68288557 C099768 CSG <br /> 24 HR EMERGENCY #1-800-468-1760 (SK ! TFI) <br /> 2uTH AS ,r rrWFI-F�ic;aPV <br /> 15. GENERATOR'SlOFFEROR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national govemmental 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 Acknowledgment 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 m a small qua tity generator)is true. <br /> GpneratoeslOfferof P'nted/TypedN Signa re Month Day Year <br /> )-7) <br /> J 16.Intemation Shipments <br /> z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporterAckroWedgment of Receipt of Materials <br /> Tr n porter 1 PriedlTyped Na Signatu Monti Day Year <br /> aZ Trans /ri/nted/Typed Name / Month Qay^ aria- <br /> C'7 <br /> 18. iscrepancy <br /> 18a Disrre.pan y Indiratinn Sparc. <br /> Quantity E:1 Type ❑Residue ❑Petlial Rejekiiult El Full Reiecliuri <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> W 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> H <br /> Z <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1- I /w 2. 3. 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedlfyped Name Signature '111 <br /> q h Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FAC TO DESTINATION STATE(IF REQUIRED) <br /> 1)7479378/809842 <br />