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HIP '2 81 9.43 � r, <br /> Pleas2 00dr tyle.'" :: '+, w. For Approved:•OMB No,2050-0039 <br /> UNIFORM HAZARQ>�US'' 1aG)s ator ID Number 2,Page of 3. me R e P 4.Manifest Ttackin Number <br /> q s <br /> �v 1!479 KS <br /> WASTE MANIFE ' <br /> 5.Generator's No antl Mpjiin&dres$,a, " Generator's Site Address(if different than mailing address) <br /> 4 AD Vden Sat6; ADESA - Gold6w.`Sate <br /> 1850.1 4�es��Stanford Rd Attn Samuel Mchenry 18501 Stanfoi^d -Rd <br /> TRACY CA 95377 Attn' Lest4r Sabo <br /> Generator's Phone; SO _ , 1/a-537�o TRACY CA 95377-9708 <br /> U.S.EPA ID Number <br /> s.Trpj �Gp^ 'y_ SYSTEMS INC, TXT 812 <br /> 7.Transporter 2Company,Name U.S.EPA ID Number <br /> CLEAWHAROQRS ENVIRONMENTAL SVC INC. AD0393�SS 0 <br /> 8,Designated Facility Name and Site Address U.&EPA ID Number <br /> CLEANHARBORS OF BUTTONWILLOW <br /> 2500 LOKERN ROAD <br /> . BUTTONWILLOWICA..S,32 <br /> 661-762- { CAD980675276 <br /> Fa j4tes Phone: <br /> 9a. 9b.U.S.-DOTDescription(including Proper Shipping Name,Hazard Glass,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.iQlasfe Codes <br /> HM and Packing Group(if any)) , No. T pe Quantity Wt.Nol.' <br /> NON-RCRA HAZARDOUS k3AT4 P 134, ; <br /> o LIEU DS, (DIESEL RXAUST FLUID), <br /> 27 <br /> x 3:' <br /> 4 <br /> f p <br /> - f <br /> 14.S Handling Instructions and Additional Information 'I CBL 79653754 AI}2101 1SS S <br /> t , <br /> 0\ -t a �-� <br /> t.. ' <br /> ` �.�244H'ENSR NCY 8 4613"1760-CH/S ITFI�-C®ntra�t v!stained by generator confers afor, <br /> envy author:i y <br /> initial to add or substitute i t o ,s <br /> 1 , GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that thermntents 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 tional 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 EPAAeknowiedgment of Conse <br /> I certify that the wastetninimization statement ide'S Nd in 40 CFR 262:,7(a)(if I am a large quantity generator)or(b)(if I a, a small quantity generator)is true. <br /> IE==/Offerors Print yped Nam Slgjrakure, Month Day Year <br /> 16.Intgmationai Shipments: ." <br /> r D Import to U.S. Export from ff.S. Port of entrylexit: <br /> ? 'Transporfer signature(for,exports only): Date leaving U.S.: ' <br /> m-^` ie 17.Tra'nsporierAcknowledgment of Receipt of Materials <br /> s n 1 Printed/Typed N e ignature Montb Day Year <br /> o P'c7✓ ! <br /> Trans er 2 Printed ame re Mg h Day Year <br /> 2 2 <br /> R 1 4;--tM7t <br /> 18; iscrepancy <br /> 18a.biscrepancy Indication Space ❑ Quantity 1:1 Type. 1r�:1 L__J Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number ; <br /> Facility's Phone: <br /> r W 18c.Signature ofAltemate Facility(or Generator) Month Day Year.' <br /> N 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems). <br /> LU <br /> 0�_ <br /> i <br /> 4. <br /> 20.Designated Fa' wner or Operator,;Certification Jrecelpt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed m gnalure," Month Dpy Y r' <br /> . ` <br /> EPA Form 8700-22(Rev.12-17)1 Aievious ditions are obsolete. G DESIGNATEb FACILITY TO GENE T0� <br /> 1?8547776/I " 7&7 <br />