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�z3g�'aq IIIIIIIIIINl �lllnl� <br /> SSL SK SHIP# 2e3848ROFT— <br /> Please print or type.(Form designed for use on elite 12-pitch)typewriter.) 0 0 6 Form 3 4 0 . S K S <br /> g ( Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL600352832 2.Pae 1 of i ETMIR-4wnslift 4 1006193406"ffest a7�(a7 <br /> ber <br /> WASTE MANIFEST <br /> 5. aerators Name and Mailing Address Generator's Site Address(it different than mailing address) <br /> l ardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 785-690-0109 <br /> '§W&1-40PN"`SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7 Trens 2 Com n Name U.S.EPA ID Number <br /> CLd HARORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Desgraled 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 /> 310-835—'9998 CAD044429835 <br /> Facility's Phone: <br /> ga. 96.U.S.DDT Description(srdWug Proper Shipping Name,Hazard Claes,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM mKIPatirinlIGMU (taro)1 No. Type Quantity Www. <br /> 1NON-RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> (OIL FILTERS) <br /> z z. <br /> w <br /> 3. <br /> 4. <br /> 14.Spedel Handling Instruction and Additional Information TSD:WI GR15065 DCS � <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) (�^JJ j <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY s <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 dessified,packaged, <br /> marked and IabeleNplacmded,and am in all respects in proper condition for transport according to applicable international and national governmental regulations.N export stupment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the term of the attached EPAAd vwvledgment of Consent. <br /> I certfy that the waste minimization statement identified in 40 CFR 262.27(a)(tl I am a large quantity generator)or(b)(dl am a small quantity generator)is true. <br /> Generstor'sh0lferm's Pnnted[Typed Name Signature Month Day Year <br /> v w ,a�lv�t_Z <br /> J 18.Intemahonal Shipments <br /> F ❑Import to U.S. ❑Export trrn U.S. Pont of entry/ext: <br /> = Transporter signaWre(for exports only): Dale leaving U.S.: <br /> a' 17.TrarepdterAdmoMedgment of Receipt of Materials <br /> Ti Aped Ne SgnaWre Month Da Year <br /> N 1I <br /> Q Treneponer2 Name alum - Month Day Year <br /> t18.Discrepancy <br /> Its.Discmi aM Indication Space ElOuantity ElType ❑ReA, ❑Portal Rej o, ❑Full Rgedion <br /> Manifest Reference Number. <br /> 18b.Aftemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Fadlitys Ph": <br /> W1&.Signature ofAtemate Facky(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste mament,disposai,and recycling systems) <br /> G 1. 2. 3. 4. <br /> 1 SAI <br /> 20.Designated Fac ky Owner or Operator Certification of receipt of hazardous matenals covered by the mantles)except as noted in Item 18a <br /> Printed/Typed Name71 <br /> Signature Monts Day Year <br /> ly n 2i 11 <br /> EPA EOOn.f%jj(/R2vtj))P Aous editions are obsolete. DESIGNATED ACILITY TO DESTINATION STATE(IF REQUIRED) <br />