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SK SHTill 027484 739 11111111111111111111 oil III III ^� 0057758005K3 Please print or type. pC Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number s 2.Page 1 of 3. m R s e P 4.Manifest Tracking Number � I_ 1 1 '' ' 1006776800 SKS WASTE MANIFEST 5.Generator's Name and Mailin Address Generator's Site Address(if different than mailing address) Les Schwab Tg1.re Coni t=r� Sf,S 3260 W CraT1t Line Rd TRACY CA 95304-8427 Generators Phore: 209-835-4029 6.TrW j1�Co &-.q SYSTEMS I C U S.EPA ID Number TX R00008 F 205 7.Transporter 2 Gam an Name U.S.EPA ID Number CLEAN 9WB'll4S ENVIRONMENTAL SVC 1NC- MAD039322E51+ 8.Designated Facii4y Name and Site Address CLEAN HARBORS ENVIRONMENTAL SERVICES, TN U.S.EPA ID Number 2247 S HIGHWAY 71 ,rye 8-235-4012 KT!>iBRL.L � NE6-1145y,� _ Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit13.Waste Codes HM and cking Group(if any)) No. Type Quantity Wt.Nol. 1.HE NON RCRA HAZARDOUS WASTE LIQUIDS � DM /1'j sgi ;'43 Qo , (GLYCOL ETHER, WATER), q,. LLQ Z 2. ill C7 3, 4 14.Special Handling Instructions and Additional Information TSD d Kir 790.154 S r 153 _ C Q 24H EER ENC`1#800- 468-17E0—CH/SK/TFl—Contract retained by fgen rator €onfer~s agency .41-tthf)r=i y on initial transporter to add or substitktte additional transporters on enera nr' s behalf. 15. GENERATOR'SfOFFEROR'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, marked and labeledlplacarded,and are in all respects in proper oenditior for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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. Generator's/Offerors PdnledlTyped Name / Sign lure Month Day Year J 16.Inteffationil Si ❑ ❑ F Import to U.S. Export from U. Port of entrylexit: X Transporter signature(for exports only), Date leaving U.S.: Ce 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PhntedlTyped Name AVE- A N Signature Month Day Year Z Prin ed Name Signat Month Day Yea 18.Discrepancy 18a,Discrepancy Indication Space ❑ QuantityE:1T e ❑Residue Type El Rejection ❑Full Rejection Manifest Reference Number: 181 Alternate Facility(er Generator) U.S.EPA ID Number J U Facili y's Phone: w 18c.Signature ofAltemate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 180 PrintedlTyped Na Signature �feFsgth y CIA Mir j V'll 3 ±DA� .�(A j EPt Fag -q . �9-Ag viou ons are ob olete. DESIGNATE[?FAClLlTY TO EPA's B-hIIANIFEST SYSTE