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sL SK SHIP# 231267088 <br /> Please print or type. 0 O 7 4 7 6 d 9 7 S K 8 <br /> 1.Generator ID Number Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS COLO 2,Page]E��� 0.07476697 <br /> WASTE MANIFEST �� <br /> 5.Generators Name antl Mallin Address Generators Site Address(if different than mailing addross) <br /> Les Schwab Tire Center 665 <br /> 3 W Grant Line Rd <br /> TRACY CA 304_8427 <br /> Generator's Phone: 209-835-4029 <br /> 6.Tr q� �m n4q SYSTEMS INCU.s,EPA ID Number TK ROO 091215 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MA 9322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE, LLC U.S.EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> ARAGON I TE , UT 2 <br /> LJTD981 5 <br /> 435-884 .8100 177 <br /> Facility's Phone: <br /> 9a, 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)) No. Type Quantity M.Nol. 13.Waste Codes <br /> NON RCR HAZARDOUS WASTE LIQUIDS � DM J ill R 343 <br /> o , UYCOL ETHER, WATER), -NW <br /> ua <br /> W <br /> 3. <br /> 4. <br /> 14.Speaal Handling Instructions and Additional Information TSD-.AG 83012872 LE 15385 CSG <br /> a 0011 <br /> 24H Eh ICY#800 -468-1760-CH/SK/TF'I--Contract r tained y generat r c r fen � �uthari y <br /> ren initial transporter o add or substitute additional transporters on enera or's behalf. <br /> 15. GENERATOR'S10FFER6R%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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulators.If export shipment and I am the Primary <br /> Exporter,i certify that the contents of this consignment oonform to the terms of the attached EPAAcknowfedgment of Consent, <br /> 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. <br /> Generato' Offerors PrtntadlT pC Sig <br /> -�Name • nature Month Day Year <br /> 16.Enter att a Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> uj Transporter n d ped Name Si nature <br /> o 9 Month Day Year <br /> tZ <br /> Transpo ter 2 Printedffyped Name gna e t Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space <br /> Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> �} 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> FacilAy's Phone: <br /> Lu 18c.Signature o#Alternate Facility(or Generator) Month Day Year <br /> Q <br /> a <br /> 19.Hazardous Waste Report Management Method Codes((e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> 1 � 2. 3. 7- <br /> 20. <br /> Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Itam 1 B <br /> Printed aerre Sig tore Month Da Year <br /> FPA F <br /> ) qqj f2ev1 12)DP�evia a 't tt o t DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1q3 c <br />