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SSL SK SHIP#-2e9+4da a 11HIIHIUglll11111111llllilllltlil <br /> p iSiLifs3fl 0071590468K >s <br /> Please print or type. Form Approved,OMB No.2050-0039 <br /> UNIF01 HAZARDOUS 1,Generator ID Number 2.Page 1 of 3. me Res Qse P 4.Mast TkiNumber <br /> .,MATE MANIFEST CAL000346875 —4��—i' s0 1067199048 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(If different than mailing address) <br /> ADESA — Golden Gate ADESA — Golden Gate <br /> 18501 West Stanford Rd Attn Samuel Mchenry 18581 Stanford Rd <br /> TRACY CA 95377 Attu. Lester Sabo <br /> Generator's Phone: !"14-5374 TRACY CA 95377.-9708 <br /> tilftiMM SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS NV f19MIMC r�+ 7 bi U.S.EPA ID Number [� <br /> IT 749 —41c- <br /> K�s�l,�sfA0u-eB, u y` <br /> Facility's 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(il any)) <br /> No. Type Quantity. Wt.Nol, <br /> X 1• UN1203, WASTE GASOLINE MIXTURE, 39 PG II DM P D001 D018 '213 <br /> 0 <br /> z 2 <br /> W <br /> C9 <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information TSD:KP 81102185 AD20198 CSS.. y <br /> 1)ERG#128 [—(�t(7 4-9;!11 �..J <br /> 24H.EME Y#800-468-1760-CH/SK/TFI—Contract retained by generator confers a ency authori <br /> 15. GENERATOR'SfOF tRT1FtCAT10N: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded atlf arein all respects in proper condition for transport according to applicable intemationai a ational governmental regulations.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 EPAAcknowledgment of Cons <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 a smai uantity generator)is true. <br /> erors P'tedtfyped Name Signature Month Day Year <br /> oft <br /> 16.international ShVTnents E]IMP4 to U.S. ❑Expo try <br /> rt from U.S. Pori of en !exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter AcknowlWgmentofReceiptofMaterials <br /> �Pd,*M gnatureMonth Day Year <br /> :? <br /> er 2 Pnted/T me <br /> Month Day Ye <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space quantity [:)Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generates) t r U.S.EPA ID Number <br /> J <br /> V <br /> LL FaciliVs Phone: <br /> 18c;Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 019.Hazardous Waste Repor(Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 2• 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manffest except as noted in Item 18a <br /> Printed/T ame S' re on 0 Ye <br /> EPA Form 8700-22((Rev.12-17) Previou ill ns ate obsolete: DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)8461821/1716993 <br />