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i; :.:.� `," '"`T":, it • il'I��'t�'�F������I�����I�■H , <br /> ' M <br /> 0 0 5 9 4 6 a a 2 S K S i <br /> Pi eese print or type.{Fgrm dgsignedfor use on ehTC'(fitdtjpewdtec) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS tGenerator ID Number 2.Page 1 of 3. m R s Manifest Tracking Number <br /> CAL@00352832 1 s= 8 4. <br /> MANIFEST 005946882 SKS <br /> W - j <br /> 5.Generarsom Name and Mailing Addfess Generators Site Address if different than mailing address) <br /> Gardner TruckxnglClassic Sales In <br /> 2577 W Yosell Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 785--690-0109 <br /> SYSTEMS INC U.S.EPA ID Number TXROOOO81205 <br /> "r "0 <br /> 2 CCo�m an Name U.S.EPA ID Number = <br /> CLEAN 1=B'ORS ENVIRONMENTAL SERVICES INC MAD039322250 ' <br /> B.Designated Facility Name and Site Address CLEAN HARBORS OF WILMINGTON LLC U.S.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON CA 90744 <br /> 31@-835-9998 CAD044429835 <br /> Facility's Phone: j <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 73.Waste Codes <br /> 9a. 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1 NON—RCRA HAZARDOUS WASTE' SOLID ON 250 P 223 <br /> (OIL FILTERS) <br /> a' <br /> 2. <br /> w <br /> ul <br /> (!1 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:WI GA15065 (V(V,, CSG. <br /> 24 AUTNRASM"AGENT—FOENCY R"HY GEENN TO RETAIN ET N! TFI)L LICENSED SUB CARRIERS NECEJ3SARYI — 1 • <br /> 15. GENERATOR'S/OFFEROR'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 N the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 OFR 262.27(a)(if I am a large quantity generator)or(d)(if I am a small quantity,generator)is true. <br /> Generator's/Ofiefor'S PrintedlTyped Name Signature Month Day Year <br /> - X akviDvD Ak lijare <br /> � 16.Internammal Shipments <br /> i Import to U.S. ❑Expert from U.S. Port ofentry/exA: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TramporterAdmowledgment of Receipt of Materials <br /> Transporter 1 Pnnted/Typed Name Si lure Mon Day Year <br /> a' L% q i <br /> Qit r 2 PdntedTyped Name Si r Month Dayy—em— <br /> err <br /> LZFS (7 <br /> }. 18. iscrepancy IV <br /> 18a.Discrepancy Indication Spacety ❑ ❑R ❑ I ❑Full Reil#' 60 <br /> ❑ Quanfi Type Residue Parfial Rejection <br /> Manliest Reference Number: <br /> I� 186.Attemate Facility(or Generetor) U.S.EPA ID Number <br /> J <br /> ,j <br /> rai -acilityy's Phone: <br /> L18c.SignaWreoFNtemate Facility(or Gereciter) Month Day Year <br /> :L <br /> y9.Hazardous Waste Repel Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3. 4. <br /> A Dsatopaled Facrfi(y Owviet or operator;Certificated of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> F hriCdNatne <br /> Signature Month Day' Year <br /> ' �Yt�2S10 Anol6q �,Q 5 Ib 1� <br /> T <br /> v.3-05 Previous editlons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE IF REQUIRED <br /> r 3,t, r7t <br />