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� a <br /> C <br /> uSe,t7t1.41e 2.. Form Approved.OMB t4b,20 39 <br /> Y,Garr aCoY IfJ Number I'- <br /> Pae 101 <br /> E ey s 4.Manftst Traektn turn r - <br /> 006 4 0 SK <br /> s and MaitirigAddress Generators Site Address(if different than mailing address) <br /> .9 .Rentals <br /> t Way <br /> amara: Phrsne; 1 <br /> Y a` INC U.S.EPA IO Number T X RO 1 <br /> 205 <br /> 7 Tianspoiiar 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS # I AL SVC I C� <br /> DOsigriateti Facllity Name and site Address CLEAN FSS OF WILMINGTONLLC U.S.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON � CA 90744 <br /> 310-835-9998 . 442 <br /> Fact. S Phone: <br /> �. 9b;JU.S.DOT Description(including Proper Shipping Name,Hazard Class,tD Number, 10.Containers 11.Tota! 12.Unit 13.Waste Codes <br /> F1'M .and Packing Group(if any)) No. Type Quantity M.Nol. <br /> '-WN-RCRAHAZARDOUS WASTE, SOLI223 <br /> (OIL ILTER ) „� <br /> l5 <br /> 3' <br /> 4. .. <br /> 14.Special Handling Instructions and Additional Information TGD�Wl 755182495 TC10591 CSS <br /> Y 0-800-468-1760 ( / T � l rw <br /> CAN -DC9" <br /> 15, GENEM MkfSIOFFFR0R'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,packagei <br /> mad4d and labetedlptacarded,and are in all respects in proper condition for transport according to applicable inte and national gov®mmenlal tions.If export shipment and I am the Primary <br /> Exporter,I ce*that the contents of this consignment conform to the terms of the attached EPAA luiowledgment of C ent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(h I am a large quant ty generator)or(b) am a small quantity gen r)is true. <br /> Gerierator`5qftoes PrrntedrrMd Name Signature litMonth Day Year <br /> 01. XL IS <br /> 0-1-jejo'E62 <br /> J 16.International SNpmefits <br /> F, ❑Import to U.S. ❑Export from U.S. Port a Je t: <br /> Transporter signature(far exports only): D leaving U. <br /> 17.T r Ac4xyMedgment of Receipt of Materials <br /> 1 PrirttedfTyp e Signature Month Day Y <br /> Ttahsoortetri me Signature onlh y Year <br /> : <br /> L1 L <br /> [)iscrspancy <br /> EI <br /> �7 <br /> t$a biserepancylndication Space ❑ Quantity ❑Type LJ Residue Partial on l_._f Full Reject. <br /> s� <br /> Manifest Reference Numbs <br /> 1 Afwnate f acility(or Generator) U.S.EPA ID Number <br /> r3f,4tteimat6 Facility(or Generator) NH»dh bay Year <br /> iteport iartagement Mefftod Codes(Le,,codes for hazardous waste treatment,disposal,arid recycling systems) <br /> 2 _ 3 4 <br /> 4fi ter CsriHis flon pt rece4tt of hazardous Mriats cdvered byr the manPfestexceptas nctarihem 18' <br /> Signature <br /> +3 <br /> editlQnS are' l t ofete. DIESIGN Al` FiiAoL1r °o CxeONMION <br />