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SSL SK SHIP# ?310490LT <br /> � Form Approved,OMB No,2050.0039 <br /> Please p� not or type. 4.Manifest Traacking�NNul�mber <br /> 1 Generator ID Number 2.Page 1 of 3 R s o se P ®®�">t' v �+�/ <br /> UNIFORM HI ZARDOUS`• CALOW451625 1 f r - ,a-il9fb0 �'� S SKS <br /> WASTE MANIFEST <br /> Generator's Site Address(if different than mailing addross) <br /> 5.Generetor's Name and Mailing Address <br /> All Star Heavy Haul & Towing Inc RECEIVED APR 1811 <br /> 850 North MacArthur Dr CA 95376-0000 <br /> TRACY <br /> Generator's Phone: 9 833— 107 U.S.EPA ID Number T X R00Qk0812Q15 <br /> 6 Tr rj!$`cyoWJy 99, SYSTEMS INC <br /> U.S.EPA ID Number MAD0393222:1-30 <br /> 7.Transporter 2 Company Name <br /> CLEAN HARBORS ENV SVC INC. U.S.EPA ID Nun,l, <br /> 8,Designated Facility Name antl Site Address CLEAN HARBURS SAN .1075E <br /> 1821Ja05RRYESSA ROAD ! CA 95133 <br /> SANCADQ1594943i 1 QI <br /> 409--441-0962 <br /> Facility's Phone: <br /> 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No Type Quantity wt.Nol. <br /> HM and Packing Group(if any)) P 39,p- <br /> 1 <br /> (AgSDRNOhl RCRA HAZARDOUS WASTE SOLIDS, , DM I�G� <br /> Ix BENTS C12NTAMINATED WITH OIL), -�Mfl-- <br /> a <br /> w <br /> w <br /> 3 <br /> r <br /> 14.Special Handling InsWc6ons and Additional Information 1 SD!CJ`a 9277835Et f�L•4 111 CSG! <br /> / - ontract rei:ai,ned by venerator confe►'' agency authori y <br /> 24H EMERGE-NCYd#r8@O--468-t760- Contract TFI C G <br /> �Anrtc+r to add or substituto additional tranc-porters on pener <br /> 5 GENERA70R'S/OFFEROR5 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 certity.that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimi::ation 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. Month Day Year <br /> Signature <br /> Generators/Offeror's Pdnted/Typed Name <br /> . q,. 1 <br /> 1 .I emationa pments Import to U.S. ❑Export fro "IrPort of entrylexit: <br /> F— Date leaving U.S.: <br /> Z Transporter signature(for exports only): <br /> of 17.TransrterAcknowledgment of Receipt of Materials Month Day Year <br /> M <br /> Transporter Printe yped Name Signatu �, 0 <br /> 66�_� — I t) <br /> a ! I t - <br /> Z Transpo er 2 Pdnte ype ame <br /> S' natu Month Day Year <br /> e C/1'11Y ��.,��"-"' <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection Dull Rejection <br /> / Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> Facility's Phone: Month Day Year <br /> 18c.Signature of Alternate Facility(or Generator) <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> �'/ 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as d in Item 18a <br /> /� I �J Signature oath Y <br /> ear <br /> Prnted/Tmet J <br /> t Form 8700-22((Rev.12-17) Previous editions are obsolete. } DESIGN D FACILITY TO GENERATOR <br />!)8831607/2002069 <br />