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SSL SK <br /> Please fin fit or type.(Form designed for use on elite(12-pitch)typewriter.) ` Form Approved.OMB Na 2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Pa 3 Rg�lgpse p1g�g� I'. ar;GlJ9QNymb�r <br /> WASTE MANIFEST 35 IT, t?IM9-'4ff" l/tftl .6 1 J§7. 6©. SKS <br /> 5.Generators Name and.Mailing Address Generators SfteAddress(if different than mafmg address)1 GVix V {jf�\7 <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosesite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 785-690-0109 <br /> U S EPA ID Number <br /> 6.Tf�-xSYSTEMS, INC. U.S. <br /> 7.Transporter 2 Company Name : U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS OF WILMINGTON LLC U.S,EPA ID.Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON t CA 90744 <br /> 310-835-9998 . Gf�l044429835 <br /> Facilitys Phone: <br /> ga 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(rtany)) No. .Type Quantity... WINol <br /> NON-RCRA HAZARDOUS WASTE, SOLID DMP 223 <br /> o (OIL FILTERS) 7W <br /> z 2. <br /> w <br /> 4. <br /> 74—SpecialHandling Instructions and Additional Information TSD/WI 0A15065 CSGI <br /> 24 HRAEMERGENCY'#!-800-468-1760 (SK"AGEENT—FORBY AIN/ TFI) IcOp �cp <br /> RE <br /> AUTHLICENSED SUB CARRIERS AS N=MRY <br /> 15. GENERATOR'SIDFFEROR'S CERTIFICATION:Thereby declare that the contents of this consignment are fully and accurately described shows by the proper shipping name and are classtf aki,.packaged <br /> marked and IabeleNDlacarded,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 terns of the attached EPA Acknowledgment of Consent. <br /> I cer ifythat the waste minimization statement identifred in 40 CFR 262,27(a)(if I em a large quantity,generator)or(b)(81 am a small quantity generator)isime. <br /> GensmorslOdeme ted/Typed arae p Signature � Month Day Year <br /> 18.International Shipments <br /> ❑Import to U.S ❑Export from U.S. Pon of entry/exit: <br /> z Transporter signature(for exports only): . Date leaving U.S.: <br /> w 17. nsporter" th Y <br /> Accknowtedgmann`tt of ReceiptofMaterials <br /> g TVh t,.1C.h S re �r <br /> Q Tranri d?yped Name_ A' MOO�� <br /> 18.Discrepancy <br /> r 18a Discrepancy Indication Space ❑ puanti <br /> ty ❑Type El Residue El Partial ❑Full ReJecbon <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> ..Tai Facility's Phone: <br /> w <br /> 18c.Signature of Alternate Facility(a Generator) Month Day Year <br /> z <br /> !S2 19.Hazanlous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> GL 2. 3. 4 <br /> 20 Designated/Facility Owner or Operator Certification of receipt of hazamous materials covered by the manifest exceed in Item 18a <br /> Pnni yped Name Slgtnatu I Month I Dr Y�gr <br /> EP 7 vtousedifrortaareobsolete. . DESIGNATEDFACIUTYTOGENERATOR <br />