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SK. SHIP 226�31D02S <br /> SSk. _., <br /> Please per' or type. Form Approved.OMB No.2050-0039 <br /> NIFORM HAZARDOUS` 1.Generator ID Number 2.Paget of 3. m R s e P 4 Manifest Tracking Number <br /> CALOd�34667 1 -- � � i'' '�� <br /> WASTE MIFE <br /> ANST 38,65 SKS <br /> 5.Generator's Name and Malin Address Generator's Site Address(if different than mailingaddress) <br /> ADESA -• Cinid�en Gate ' ADESA -- GoldenSae <br /> 18501 4West Stanf9rd ,B4 Attnt Samuel,,..Mcheinry 16501 Stanford Rd <br /> TRACY 95377 CA` Attn Lester S <br /> Generators Phone: 4'3744 TRACY CA 95377^9700 <br /> U.S.EPA ID Number <br /> 6, SYSr�s INC TXR a2s <br /> J <br /> 7.Transporter 2 Com anytame U.S.EPA ID Numbeo't <br /> CLEAN HARBORS ..ENVIRONMENTAL SVC INCA MAD839322250. <br /> 8.Designated Facility Name and Site Address CLEANHARDONS OF BUTTONWILLOW U.S.EPA ID Number <br /> 2500LOKERN ROAD <br /> DUTTONWILLON , CA 93206 <br /> 661!--762—6200 CAD9N675276 <br /> Facilitys Phone: <br /> ga, 9b.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 /> 1" NON-RCRA HAZARDOUS WASTE, 1w P 114 . p <br /> o . L.IGUIDS, (DIESEL EXAUST FLUID), <br /> 7 OE zf® , <br /> Z 2. <br /> Z? . <br /> `. <br /> 14,Special HandlingInstructionsand Additional Information TSD'I B,L 80425011j_ S13 ii2 F! E# E GENCY 6 -�t6S-176 CHISK/TFI-C >ntr��t re%-,Xk by �>1era tr.�Xers e10 y auther 1v <br /> 15�GEN RATO S OFFER R S CERTIFICATION: I he®by'ddcladre that e contentssubstitute <br /> itconts'�gnme�nt�a edflilty and accaurat="°trait a ortI ont " einem ors s behal fi <br /> of ely tied above by th proper shipping name,and are classified,Packaged, " <br /> 'marked and Iatieled/placarded,and are in all respects in proper condition for transport according to app• le international and a ,nal govemme egulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknow dgment of Conse <br /> certify tha <br /> e.minimization statement in 40 CFR-262.27(a)(if I am a large quantity generator)or(b)(if I a a mall quantity generator)is true.' <br /> Gen aratoes/ .fW rinted/Typed Name Signature Month Day Year <br /> ><s <br /> F i6 Intematidoal Shipme s <br /> Import to .S: ❑Exportfrom Poitpf entrylexit {" <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> o✓ I7JransportdrAcknoWedgmehtofReceipt ofMaterials <br /> Uj <br /> spo 1 PrintedrTyped Name � Signature Month Day Year <br /> CL <br /> QTransporter:2 Prin ame ure Month !Day Ye ' <br /> OF rte' <br /> 18,Discrepancy <br /> 18a.Discrepancy Indica tion,&ace ;. y Partial e'ection <br /> ❑ Quantity Type t" Residue R j 0 Full Rejection <br /> 'c <br /> Manifest Reference Number: <br /> ,18b:Alternate Facility(or Genetatg{) U.S,EPA ID Number <br /> J $F <br /> U_ FacilitysPhone: u <br /> t - Month Da Year. <br /> �':18c.Signature of Alternate Facility(or Generator) r Y <br /> N 19.Hazadobs Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ` � 1, 2. 3 4 <br /> 20.Designated Facilityri r Operator:Certification of receipt o azardous materials covered by the manifest except as noted in Item 18a . <br /> Printedrryped Nam ature—, Mon h D2y Year <br /> EPA Eo v � P. sous edi(i s are obsolete. IjESIGN,ATED FACILITY TO GENERATOR <br /> 1? $7' �4 1 <br /> ~i�� <br />