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ty' ray f� ly�, �r��r{{'QQ��tT,..,,r .�.JN.. SK Sf4I P# 6.G T'"I + mF" Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number CAi flQll,�a `.� 2.Page of 3.Emerq� Reoe Poi 4.Manifest Tracking Number �[ WASTE MANIFEST 10069596'428 SKS 5.Generator„',�Name nd Mailing k dress Generator's Site Address(if different than mailing address) JC it'°�ttw''�ingg I'nc 1415 Ww Anderson St, 'S°C'0CKTON CA 95206-0000 Generator's Phone: 6.Tara p�d m6gt_y t°V SYSTEMS I U.S.EPA ID Number 7.Transporter 2 Compa , Name U.S.EPA ID Number I�> D�tig32 i� l C! �bORS ENVIRONMENTAL SVC INC. 8.Designated Facility Name and Site Address CLEAN HARBORS ENV I RONME.NTAL Sf wRV I CESS IN U.S.EPA ID Number 2247 S HIGHWAY 71 K I t�HAL.L , NE 69145 308-233- ►012 NEIDS21723513 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes X 1. LIN2631 263, WASTE PAINT, 31 PG 11 fs'x P F00.1 E005 D601 O 00 D006 212 z 2. L c7 3. 4. 14.Special Handling Instructions and Additional Information TSD Z KP 79305144 .IC 10836 CSG s 1 D ERI;#128 24H iEkRGtNCY#800-468 -1760-CH/S} /TFI-Contract retained by generator confers as envy authori.y on initial transporter to acid or substitute additional transporters on enera�or"s behalf. 15. GENERATOR'SIOFFEROR'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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization 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. Generator's/Offerors Printed/Typed Name Signature Month Day Year 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of.entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials I-- Transporter 1 Printed(fyped Name Signature Month Day Year O CL Z Transporter 2 Printed/Typed Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ElType Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z u, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 1 i20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a I Printed/Typed Name Signature Month Day Year EP417 j% QO 'i e�v$1 _�Z 6P eyious editions are obsolete. GENERATOR'S INITIAL COPY