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Xti"t 377 f <br /> SSL SK SHIP# 2-18*2T@68 <br /> 0052452525 KS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generates ID Number CAD982497828 005 <br /> O� <br /> 2.Pegg 1 of 3iE�cy Pl ed 1,11, racldn4 Number �� <br /> WASTE MANIFEST 1 Jay 2 4 <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Cal Trans Shop 10 Cws <br /> 2005 Krohn Rd <br /> TRACY CA 95377--9120 <br /> Gemerator's Phone: 209-835-6779 <br /> 6.Tgrt�ompagy Name SYSTEMS, INC. U.S.EPA ID Number <br /> Y—F(LtEEV , TXROOOO81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS BUTTONWILLOW, LLC U.S.EPA 10 Number <br /> 2510 LOKERN ROAD <br /> Faal' s Phage: <br /> BUTT(3NWILLOW , CA 9,x206 <br /> 661--752-6200 CAD980675276 <br /> ` <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WtNol. <br /> '. NON RCRA HAZARDOUS WASTE SOLIDS (NON DM � P 352 <br /> o RCRA HAZARDOUS WASTE SOLID (ABSbRBENT <br /> aa� AND OIL) ) <br /> z 2. <br /> W <br /> [9 <br /> 3. <br /> 4. <br /> 14.Special Handling Inslnoonsand AdditiordInformation TSD BL CA4795lIt CSO; <br /> ��3 I' <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TEI) <br /> AUTH AS 11 FI <br /> BY GEN TO RETAIN [ IrENSFn SHR CaHRTFRS AS NFr_FS_qARY <br /> 15. GENERATOWSIOFFEROR'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 labeledrplacarded,and are in all respects in proper condition far transport according to applicable international and national govemawdal regulations,ff export shipmerd and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent. <br /> riify that the waste minimization statement identified in 40 CFR 262.27(a)('d I am a large quantity generator)or(b)(if I am a small quantity erata)Is <br /> s Pri me re <br /> J .International Shipmen <br /> z ❑Import to U.S. 1:1 Export from U.S. Pat of a lextt: <br /> Transporter signature(for exports only): Date lea <br /> W 17.TMporterAcknowiedgment of Receipt of 93teria4s <br /> 6i Tres 1 1"rinted/Typec^me Signature M <br /> O <br /> i <br /> H <br /> Q Transporter yped Name Signature Month Day ear <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> ' Manifest Reference Number. <br /> f8b.Aternate Facility(es Generator) It, U.S.EPA ID Number <br /> J_ <br /> Facility's Phone: <br /> U jj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes p.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1' <br /> H132 <br /> 20.Designated Facility Owner or Operator.Cedificabon of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedffyped Name SignatureMonth Day Year <br /> JD2f <br /> !6 <br /> EPA Form 8700-22(Rev.3-05) Previous editiv re obsolete. DESIGNATED FACILITt.06 DESTINATION STATE(IF REQUIRED) <br /> 1)7297042/40712992 <br />