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SSL SK SHIP# Iilllllillllidlll11111�11111111�IIIIiI <br /> J 7 <br /> �9�s8b 55 ie;>' <br /> Please print or type.(Form designed for use on elite 12-pig CJ 0 5 °i 3 1 g "�' S I: 5 <br /> rypewn er.J <br /> UNIFORM HAZARDOUS 1.Geneator ID Number CAD050365188 2 Pag�=71 <br /> Form Approved.0MI3 No'2050-0039 <br /> WASTE MANIFEST 4.Manifest Trackin'g)Number5.G nerator's Nam nd Mailing Addres, 0055 L 2197 SKS <br /> (�aeran torp Genemtor'sSdegtltlress(ifcifferentthanmailingaddmssJ <br /> 10108 W Lining! Rd <br /> TRACY CA 95377-9122 <br /> Generators Phone 209-836-5050 <br /> 6.TjgnflFOfeSY3'rENS, INC. ------- <br /> U.S.EPA ID Number <br /> 7.Transporter2CompanyName®„ I TXR0000191205 <br /> �� rfn if��7yy EPAI�D Number <br /> B.Designated Facility Name and Site Atltlress CL ANfiARBOR5 AGONITf. LL—�--.—� —=—_ <br /> 11600 NORTH APTUS ROAD J.S.EPA ID Number <br /> 435-884-8100 ARAGONITE , UT 84029 <br /> Faciliryys Phone - <br /> UTD981552177 <br /> ga. 91b.U.S.DOT Description(inouding Proper Shipping Name,Hazard Class,ID Number, <br /> HM and Packing Group if any)) 10.Containers 11.Total 12.Unit <br /> X 1. NA3082, HAZflRDOi1S WASTE„ LIQUID - No. Type Quantity Wt.rom 13.Waste Code, <br /> 0 N.O.S., (CADMIUM, LEAD), 9, PG III IIM P D00fi D007 D008 <br /> w <br /> Z z. / f 252 <br /> w - <br /> C7 <br /> 3. <br /> 4. _ <br /> 14 Special Handling Instructions and Addition allnfonnalion r <br /> T.oD;fl6 - <br /> AM 19454 <br /> 1)ERG#171 CSB. <br /> 24 HR EMOBENCY #1-800-468-1760 (SK / TFI) �1 <br /> SEE ATTACHMENT (1e6 -j Z5 J <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: Iheneby declare that thecontentsof this consignmentare fully andaccu�ately describedawve by me proper shipping name,and are classified,pact aged, <br /> marked and labeled/placardetl,and are it all respects in proper condition for transport according to apptaable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consign tit conform(o the tenns of the attached EPAAcknovlodgment of Consent. <br /> I cenify that the waste min izadon statement' entified in 40 CI'R 262.270)(if I am a large quantity gererator)or(b)fill am a small quantih,gen ator)is tore. <br /> Generato' eron's intedl7y ed Name - <br /> { ,„� Sig.afore <br /> Month Da Year <br /> � 18.mtematlonal Shipments r ` I � Il� <br /> ~ ❑I rtto U.S. <br /> Transporter signature(for exports only): ❑Export from ll:>. <br /> Part of entry/exit:_ <br /> Date leaving U.S.' <br /> w17.Transporter Acknowledgment of Receipt of Materials -�_ — <br /> X Transporter 1 Prin(edlTyped Name <br /> O Sigratur_e�— <br /> a I Month Day Year <br /> QTranspc 2 Printed/typed Name <br /> IY h / ' <br /> � U�4"1 �d 9 a <br /> r- Month Day Year <br /> 18,Di reparoy <br /> Isis,Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility(or Generator) _ Manifest Ref_ elude Number <br /> J <br /> U <br /> U.S.E?A ID Number <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> ZMonGl Day Year <br /> N19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous wastetreatment,disposal,andrecycling systems) L <br /> W 1 <br /> FF q <br /> 20.Designate Faality Owner or Operator CerGfioaton prompt receipt of hazardous materials covered by the Mani 2 pt as coed in <br /> Pnnte a ( - .. _ <br /> i 1 AUK l N 1 f 1 ar <br /> E�F�64a�+ �-882tRviouseditions-are obsolete. — "t[•VV" /'x�/` t <br /> D 1a GNATED FACILITY TO DESTINATION STATE(IFREQUIRED) <br />