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SSL SK SHIP# 225034305 <br /> Pleaseprint' or .(Form designed far use Dn elile(12-pitch .) INNit 0 l9 6 Fo mAppprt�d OMB No.2050.0039 <br /> UNIFORWHAZARDOUS 1.Gerreralor ID Number 2.Page 1 of 3.Emergency Response Phone 4.Yal <br /> WASTE(MANIFEST CAL000312206 11 1-800-468--1760 1006136187 SKS <br /> 5.Generator's Name and McNing Address GeneraWs Site Address(d ditent firer mailing address) <br /> Les Schwab Tire Center 665 <br /> 3260 W Grant Line Rd <br /> TRACY CA 95304-8427 <br /> Gar>emws Plans <br /> &Trarreporler 1 Comparry Name U.S.EPA ID Number <br /> SAFETY-KLEEN SYSTEMS INC TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322251 <br /> 8.De*aled Facility Name and Site Address U.S.EPA ID Number <br /> CLEAN HARBORS. ENVIRONMENTAL SERVICES, IN <br /> 2247 S HIGHWAY 71 <br /> KIMBALL , NE 59145 <br /> FeAWs Ph". 308-235-4012 NED9817235t? <br /> ga. 9b.U.S.DOT Des croon(kluding Proper Shipping Name,Hazard Class,ID Number, 10.Contaarers 11.Total Q.Unit 13.Waste Codes <br /> FAM end P2d0V CM (dsnY)) No. Type Quantity vAmi. <br /> 1. <br /> NONE NON RCRA HAZARDOUS WASTE L IoLIIDS � DM ,+� P 343 <br /> (6LYCOL ETHER, WATER), NIA + <br /> W 2 <br /> G� <br /> 3. <br /> 4, <br /> 14.Special Ha Ong Instructions and AddiiYimd lafdmalon <br /> TSD:KP 76429915 LE15385 CSG: <br /> 24 HR EMERGENCY #1-riRW-468-176@ (CHI SK 1 TFI) I L4 <br /> 1 . : I tfAfaft WfNWa am be frame,ard are classified,packaged, <br /> marked and labeledlplacerded,and are Ind respects In proper condition for transport according to applicable Intemadonaland national govemmenW regulations.it export shipment and I am the Primary <br /> ^ Exporter,I cv*that the contents offt consomerd conform to the terra of the attached EPAAcknaNledgment of carserd. <br /> V I certify the the waste minimization statement identified In 40 CFR 262,27(x)(if I am a large quantity gawabr)or(b ('dt am a sural qum*genermor)is true. <br /> 1 _yped Name Mordh Day Year <br /> 0kA <br /> J 16.Ind Shonents ❑Nnport In U.S. ❑EVort from U.S. Pat of entrylok <br /> Transports signature(for exports-0): Date leaving U.S.: <br /> 17.TremsporterAdaroxdstlgrrrent of Receipt of Materials <br /> Transporter 1 PrirrtedfTypedName � — y Signature � Month Day Year <br /> �J1 C)-g 12-311 <br /> raasporW2PrtntedfT Signshxe month Day Year <br /> 3 -7 b' <br /> 18.Discrepancy <br /> 18a.Discrepancy Irrdcalon Space ❑ ❑Type ❑Residue ❑Partial Rej'A' ❑FuH Rejection <br /> MRanifest Re*wm Number. <br /> 18b.Alternate Facility(a Generator) U.S.EPA ID Number <br /> V <br /> W Fadely'S Phone: <br /> 18c.S'rg mb-ofA%mate Facility(a Generator) Day Year <br /> 19.Hazardous Waft Report Meregerrrent Method Coda(Ls.,codes br hazardous waste treatrnerd,disposal,and recyc4 sysoems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facltity Owner or Operator:Certification of reoaipt of hazardous materials covered by the manifest except as noted in Hem 18a <br /> ted/Typed Name SwIstureXMIN <br /> AMICAU <br /> EPA Form 8700-22(Rev. ) Previor�erlitiansare DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br /> 1)7879709/1325356 <br />