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SSL SK SHIP# 231267094 <br /> , 007476695SKS <br /> Pieas�print or type. PopEE Form Approved.OMB No.2050-0039 <br /> = UMOR11 HAZARDOUS +•Generator tD N CALIDN312206 2' - &1 R�+ Tracking Nwabar <br /> w6 1MMWEST fi SKS <br /> 5.Generator's Name and Mall' Address Gertera6oe's Site Address(fi d%felerll than eMmo) <br /> Les Schwab ire Center 665 <br /> 3260 W Grant Line Rd <br /> TRACY CA 95304-8427 <br /> Generator's Phone: 209-835-4029 <br /> s T��Y—Ki:ttJV SYSTEMS INC U.S. AIDNlumber TXROM81205 . <br /> 7.Transporter 2 Company Name U.S.M ID Norther <br /> CLEAN HARBORS ENV SVC INC. MAD03932 2250 <br /> 8.DasW algid Fad*Nacos ani SBe Address CLEAN HARBORS GRASSY MOUNTAIN U.S.EM ID Number . <br /> 3 MILES EAST, 7 MALES NORTH KNOLLS EXIT 41, OFF I-80 <br /> F Phone: 08 <br /> 435-854-8915 KNOLLS , UT 843 UTD991301748 ' <br /> j <br /> 9a. 9b,U.S.DoT Desai{lon(mdu ft Raper Shipping Name,Hazard Cam,ID Number, 10.containers 11.Tool 12.Unk 13.Mob codes <br /> HM and Padag C—p(if any)) No. Type away wt m. <br /> 1. NON RCRA HAZARDOUS WASTE SOLIDS (DIRT DMI P 352 <br /> SAND, SOIL, ABSORBENT AND 1130 <br /> z 2. <br /> W <br /> C9 <br /> 3. <br /> 4, <br /> 14,Spatial Iierrdtirg Inatrrrc6ona and Additional lnfartnation <br /> TSD.-GM 3$12872 LE 15385 CSG <br /> 24H EMERGENCY#R�-468-1760—CH/SK/TFI—Contract retained by generator confers agency authori l� <br /> o initial tr ns a o d r u ' <br /> 15. GEMMORWFEIRMS CERTIFICATIDN: I hereby dedare tltal the of ft eort*mwd are tiny and accurately dwmbed above by the pmpe d4og name,and are daeallsd p <br /> rmrkad and labeled oecarded,and are in ao reweds n proper condi w for trartspart aocam"to apple"ntemabmat and nabml gms a mnlat reguations,9e)port shipmentand I am tits Pdrnarry <br /> EVMW,I card-that the aonl mb of This consign wd o ANA 1D the acme d the attached EPAAdurowadgment of Consent. <br /> I M*that the waste midn&Wmn slatamertt ider*W in 40 CFR 262.27(a)(IF I an a large quantity gerw*o or(b)(d I am a small quantity generator)is true, <br /> Prutfedllyped Name 9grrahrre Mardkt Year <br /> x r 1 <br /> -j 1 .kfiernallonal SMpments <br /> ❑Import a U.S. ❑Farport firm U.S. Port d entryle <br /> Trensporar sowtune(tor mWora only): We Maung U.S.: <br /> 17.Treramim Admowledgmant of Roo*of Materials <br /> Thmsporler+ �ML -C/ signature Month Ida 1 / 106 <br /> Year <br /> TPmftnyped Nam <br /> ` trbntlt Day Year <br /> 18.Daaemicy <br /> 18a.Disaepancy ktdcatiorr Space ❑ ❑Type ❑Residue ❑Partial Rejection ❑Ful Re)mdiart <br /> Manifest Reference Number18b.Alternate Fadlly(or Generator) U.S.EPA 10 Number <br /> V <br /> FaaN"PhDne: <br /> 180.Sigoabae of Aat male Fadlly(or Generator) tfr Day Year <br /> a <br /> z <br /> 19.Hazardous WoM Report Mar�peq*VA4atltod Codes(Le.,codas for haz dDus wasW Watrrterrt,disposal,and nag t%-slams) <br /> p 1. 2 3. 4. <br /> ft/3� <br /> 20.Designated FadFty owner or OperaW Cer8flcBdon of receipt of hazardous mates)%covered by the mwdast ermepl as rded in lam 18a- d <br /> Print WT firerd vay Yew <br /> 77 <br /> J ly & <br /> EPA MM 19974 ous edidons are obsolete. MIGNATED FACILITY TO EPA's 6-MANIFEST SYSTEM <br />