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SK SHIP* 226757724 <br /> t <br /> Please print pr Type. . '• Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1:Generator ID Number 2.Pae of 3. me R e P 4.Manifest Tracking Number <br /> CAL000346675 g -11 � � � �0 SKS <br /> - <br /> 5. <br /> MANIFEST 1006686551 <br /> 5.Genp•"or's Name and Mail in Address Generators Site Address(if different than mailing address) <br /> ESA -1Solaen Gate ADESA - Golden Gate <br /> 18501 West Stanford Rd Attn Samuel iMchenry 18501 Stanford Rd <br /> TRACY t CA 55377 Attn',Leeter Sabo <br /> Generators Phone: 4 �+`7 TRACY CA 95377-9708 <br /> U.S.EPA ID Number <br /> SYSTEMS INC TXR00061205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL. SVC INCA MAD039322250 <br /> 8:Designated Facility Name-and Site Address- ,..CLEAN HARBORS-SAN. JOSE U.S.EPA ID Number <br /> 1@21 BERRYESSA ROAD ` <br /> N JOSE CA 95133 <br /> 4108-441-0962 CRD@59494310 <br /> Facilitys Phone: <br /> gaA b.U,S:DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM/ /and Packing Group(if any)) No. Type.' Quantity Wt.Nol. <br /> NON RCRA HA7ARDDUS WASTE SOLIDS, DM P 512 <br /> o f 4 Y DRUMS) <br /> i, � x <br /> 2. <br /> Uj3 <br /> t, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSI c SJ 78227502 AD20196 CSG; <br /> 24H„Et4ERGENGY 60$--4GS-°1760-CH/BKfTEI-Contract. retained by ;generator confers a eney authara y <br /> on initial trans drter'to add or subttitut'e'additional transporter-, r <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contehts of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked andlabeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and,I am the Primary <br /> Exporter,1 certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of ConseI. <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 a3 a small quantity generator)is true. <br /> Month Da Year <br /> Generator's/Offeror's Printed/Typed Name Signature ! � 1 <br /> ,,,-r16.International Shipments '' <br /> Import to U.S.. ❑Export from U.S. ort <br /> ❑ of entry/exit: <br /> �ransporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of MaterialsUj <br /> r <br /> Transporter 1 PrintedlTyped Name Signature t onth� � Year <br /> O( <br /> C_ <br /> z orte'2 Printed/Typed NamT Signal « Month DDay. I Year ' <br /> 9 -OCC C 1514 <br /> Cs <br /> 18.Discrepancy. <br /> 18a:DiscrepancyIndication Space ❑ Quantity Type yp ❑Residue El Partial Rejection El Full Rejection <br /> ❑ <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number ± <br /> t - <br /> V <br /> rar- Facility's Phone. <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method-Codes(1,e-codes,for ha'zardous,waste treatment;disposg1,and_recycling,systems)_ <br /> 1. 2. 3. 4. <br /> V4 <br /> 20:Designated Facility ne r Operator: rtification of Hipt of hazardous materials covered by the manifest except as em 18a <br /> Printed/Typed.Name )Xl� <br /> Signature h <br /> EPA o v P wious a itions are o sole e: DESIGNATED FACILITYTO GEN RAT R <br /> 1� �° y i 1 <br />