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t <br /> SSL SK SHIP# 930406104 <br /> ?�e�se print or e," . Form Appi+ved.OMB No.2050-0039 <br /> UNIFORM HA�4RDOUS 1.Generator ID Number 2.Page of 3. me�� R e P anifectTracktng Number 1307276350 �� <br /> CALM0345875 — - ` 0 <br /> 4. <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailin Address Genefator'sSiteAddress(9differentthanmaipn address) <br /> ADESA - Golden Sate ADESA - Golden Gave <br /> 18501 West Stanford Rd Attn Samuel Mchenry 18501 Stanford Rd <br /> TRACY CA 135377 Attn Lester Sabo <br /> Generator's Phone: 209-839-3882 TRACY CA 55377-9708 <br /> 6.Tr`M��p!RSPy90 SYSTEMS INC. U.S.EPA ID Number TXR000081205 <br /> J.Transporter 2 Ciomtpaln�y Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC- <br /> 8. <br /> 50 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS BRASSY MOUNTAIN U.S.EPA ID Number <br /> 3MILES EAST, 7 MILES NORTH UT KKMLSLS EXIT 41, TIFF I--80 <br /> 435-884--8515 U'tD991301748 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, W.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 0 1 NON <br /> AND -MZAR�5)WASTE SOLIDS, (USED DM P 352 <br /> z 2. <br /> W <br /> t7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TBA i GM 8P 105100 AD20198 CSG: <br /> 24H EMERGENCY#800-468-1750—CH/SK/TFI—Contract retained by generator confers a envy authority <br /> o initialtransporter to d or substitute additional r 'is be a <br /> lf <br /> 15. GENERATOR11OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurate bed above by the proper shipping name,and are classed,packaged, <br /> marked and labeledfplacarded,and are in all respects in proper condition for transport according to applicable intemationai Orm 04oral governmental regulations.If export shipment and t am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Con <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if a small quantity generator)is true. <br /> eror's Printedlryped Name Signature Month Day Year <br /> ti,. ! 24 Vii. <br /> 18.Intern onal hip ents El Imp to U.S. ❑Fxport from U.S. Port of entrytexit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAclmowledgment of Receipt of Materials <br /> sport 1 PriniedlTyped N )gnature Month Day Year <br /> Ls, r <br /> Z <br /> Printed/T ame Month Day Year <br /> 8,Discrepancy, <br /> 18a.Discrepancy indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number. <br /> J_ <br /> V <br /> 'z 1. Fadttys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 2 3. 4. <br /> 20,Designated Facility Owner or perator.Certification of receipt of hazardous materials covered by the manifest except as noted 1n Item 18a a <br /> PdntedlTyped Name Signature Month Day Year <br /> EPAForrn 8�/0- 2(Ree 1 7 Previous editions are obsolete. DESIGNATED FACILITY COPY <br /> 1)76 �r¢o IS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e•MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE. <br />