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14q � !1111111 p111INI #IIIIIIIIIII <br /> SSL SK SHIP#-eeff14J8T3E7- <br /> 006135685SKs <br /> P easpont or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS i.Generator ID Number 2 Pagge 1 of 3 Emergency Res onse PSI one 4.Manifest Tracking Number <br /> WASTE MANIFEST CALO00352832 1 I-800-460-1 16D 00613 5 685 $ S <br /> b.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Gardner Trucking/Classic Sales In <br /> 477 W 1dTE flYnsesite Ave CA 95337-9641 <br /> Gpnerat4r's Phone' "' " <br /> fi fir "; ort r i Com `. Name U.S.EPA ID Number <br /> Y-K SYST INC TX 81205 <br /> Transpoder 2Company NameU.S.EPA ID Number <br /> CLEAN HARBORS ENVIR NTAL SVC INC. NADO39322c5O <br /> '3 DeslgngtedFig 4 Name and Site Address CLEAN HARBORS OF WILMINGTON (LC US.EPAIDNumber <br /> 1737 EMT DENNI STREET <br /> WILMINGTON a CA 90744 CADO44429835 <br /> �emN'y'sPhone. <br /> #$.., g{r 1g$pqT{asddptlop4rnCladigJ'PtoperSlXfppingNartfe HazaNGass ID Number, 10.Contalners 11.Total 12.Unit 13,Waste Codes <br /> �tM� and Pa4�� dG fiCamy� .; . ,. <br /> Na Type Quantity Wt.Nol. <br /> N E3 bf IS � , SOLID DM P 223 ) <br /> 2 <br /> ( a <br /> 13. <br /> 4- <br /> 4. <br /> 1 <br /> is Span[atHerltf h; 'ficlAddififforiell h+formation TSD4WI SA15O65 CSSli <br /> 2# R l .. -#68w176O (SK t TFI)H! sty WN To RETAIN I TCENSED US CARRIFRS AS NECESSARY <br /> 18, GENERAT4R'9(GfF'Ff,RtSR".S CER YFICA%N,I thereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> me dalidYatre(d7p18C9ztiad,End-9remall mspaats in propereoaition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> rxporiec IoarGpy :(Napebienl5 d(ihls con5ggnmehtconfonn to the terms of the attached EPA Acknowledgment of Consent. <br /> lead thaf the wvgSE2,rfiUamrzgLon5latement ident' din 40CFR 26227(x)(if I am a large quantity generator)or(b)(4I am a small quantity generator)Is We. <br /> Ganefence/i3fferrnkPd+11 t�ffyp'gdlJam@ Signature Month Day Year <br /> 16 international ShlpM8id5 <br /> {'.. ❑import W U:5: ❑Expel from U.S. Pod of entry/exit <br /> g TranaMaloreguishim(l rowdy enty): Date leaving U.S.: <br /> ai 17 fir3nspodarArknew{a$grzmatoiRewrplbrMatedials <br /> 1 Oder I Pimted/Typeile Si Month Day Year <br /> lb 1 <br /> Tran3por;er2PriM >0 Name ahlre Month Dey Year <br /> r -e <br /> 18Discrepancy <br /> Ife.Discrepancy Indication Space © Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> - r 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> u: Facility's Phone: <br /> Inc.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a <br /> m 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 /> Printed/Typed Name Signature Month Day Year <br /> J CM n -A rD,.,ti-� I a l s 1(-t � <br /> F-PA Form 8700-22(Rev.3-05Previous editions are obsolete. DESIGNATED FAG1ILITYTO:DESTINATION STATE(IF REQUIREDI <br /> lI7Er22Z i3I1587�7 <br />