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SSL SK SHIP# 229979753 <br /> b0731 $ IS9 K.S <br /> Phrase print or type. Form Approved. No.2Q50.r)�t,19 <br /> UNIFORM HAZARDOUS 1 Generator ID Number FM <br /> m R s e P 4.hlanlfest racking Number <br /> WASTE MANIFEST CAL'0G4375'� �gg ��� 00731,8259 <br /> O 3 15 Q Q S�((� <br /> 5:Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) v..JJ v r,_V <br /> City of Tracy <br /> Bo de Svctr 520 Trac Blvd <br /> TRACY . CA 95376-0000 <br /> Generator's Phone <br /> 8.T n r 1 Cont''�JKKendtats SYSTEMS INC U.S.EPA ID Number <br /> TX 1205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. M#Ii0393222M <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE, LLC U.S.EPA ID Number <br /> 116M NORTH APTLIS ROAD <br /> ARAGONITE � LIT 84029 <br /> 435-894-,810! UTDW15WI77 <br /> Paagty's Phony: <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 yUl.Noi. <br /> X 1' LNN3175 WASTE SOLIDS CONTAINING ! -fit : P Dili <br /> I I_ LIQUID N.O.:6., (GASOLINE, 1- <br /> i 352 <br /> BENZ ), 4. 1, F 11 J <br /> a 2. <br /> 3. <br /> 4. <br /> :3•, yy <br /> 14.Special Handling Instructions and Additional Information TSD:AG 81647446 CI 77 CSG <br /> i)ER61„3• � x� <br /> 24#i 9b CY#9M-468-17i6@�f/ /TF'I—Contract retains generator confer- --&--y authority <br /> on initial transports a15. WM#AfiGW810FFER0R'8 C€IdIFICATIft I hereby declare that the contents of this consignment are fully and accun delydescftd above by the proper shtppbig name.and are clash,padtaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intema Tonal and national governmental regulations,t export shipmentand I am the Primary <br /> Exporter,I certify that the contents of Ws consignment conform tothe terms of the attached EPAAcknowledgment of Consent. <br /> I cedify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity generator)or(b)(if I am quantity generator)is true. <br /> GeneralorslOfferor's Primted+Fyped Name Signature Mordh Day Year <br /> )C ��'�lvK �So � t� 11'1 1 •.- <br /> r 16.Intemationai Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> �'- Transporter signature(for exports only): Date leaving U.S.: <br /> LY 17.Transporter Acknowledgment of Receipt of Materials . <br /> Tran porter 1 Primedfryped NamSign re Month Day Year <br /> V <br /> Tr 2 Primtedffyped Name 3i � <br /> cC Ci <br /> Monde Day Year <br /> 6A�_U� I e—fit 112 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity tsY ❑TYie ❑Residue ❑Partial Rejection . ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(m Generator) U.S.EPA ID Number <br /> Lh <br /> u: Facilitq's Phone: <br /> 18c.Signature Of Alternate Facility(or Generator) Month Day Year <br /> is <br /> Ury19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Ci 1 UV 2• 3. 4. <br /> — W20.Designated Facdity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as rqW in Item 18a <br /> j-L—Printedlryped NaahrreA. <br /> Month Day Year <br /> 1I 0-IN <br /> EPA, <br /> Form 4793�R� -17 Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />