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SK SH.fP# ^'76761088 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Cr P,r) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number i 2.Page 1 of 3.Emergency Response Picone 4.Manifest Tracking Number <br /> WASTE MANIFEST SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> tlafld S£df} <br /> CP '7111"15-2200 <br /> .�t;`ti5 N F3ti Fit'L a1� <br /> Generators Phone: 2009-931-7940 <br /> 6.Transporter 1 Company Name .:�TFMS, INC. U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE LLC U.S.EPA ID Number <br /> 116M NORTH ANUS ROAD <br /> ARPPnr T TE <br /> 435'"1-664-6 100 UTD981 S 521 7 <br /> Facility's Phone: <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM <br /> and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> � NN I s3.s. 11O€�IUS7 i�+l.E L 1t,?ij.i it N.0.:i, ! <br /> O :DE.CAl9�1-HYLCYCLOPENTASILOXANEk, -COMBUSTIBLE LIQUID, PG III I <br /> Z 2. <br /> 3. <br /> I <br /> 4. Vi L IN10LON �� f <br /> 14.Special Handling Instructions and Additional Information --8" <br /> SC <br /> r <br /> '4 HR EMF GFnirY 1-660-468-1760 {S} / TFI) <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 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 am a small quantity generator)is true. <br /> Generators/Offerors PnntedlTyped Name Signature Month Day Year <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17 Transporter Acknowledgment of Receipt of Matenals <br /> Transporter 1 Printed/Typed Name SignatureMonth Day Year <br /> O �✓/� <br /> Cl) Transporter 2 Pnnted/Typed Name Signature Month Day Year <br /> < �. <br /> �Jr ._.. <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity Toe ❑Residue ❑Paial Rejection Full Rejection <br /> ection <br /> Manifest Reference Number. <br /> H 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> LU 1. 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 /> Pnnted/Typed Name Signature titi .I Monthy Year <br /> ti <br /> EPA Form 8700-2Z(Rev_3 0 Pr�yious editions are obsolete. bESIGNATED FACILITY TO GENERATOR <br />