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SSL _ - SK SHIP# 232688745 111111111111111 IN 111111111111111111 0077701638KS Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page11 of 3. QspoF PIh" 14.Manifest Tracking Number CAR000039370 m -R`+`-` 007770163WASTE MANIFEST SKS 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) Escalon Premier Brands Inc. 1905 Mchenry Ave ESCALON CA 95320-0000 Generator's Phone: 209-552-6051 s.Tr soorWrf�,ony�nttR SYSTEMS INC U.S.EPA ID Number TX 8000081205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENV SVC INC. MAD039322250 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONW I LLOW U.S.EPA ID Number 2500 LOKERN ROAD BUTTONWILLOW , CA 93206 661-762-6200 CAD980675276 Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing 10 Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1 NON RCRA HAZARDOUS WASTE SOLIDS Ph; R 35-2 o (ABSbRBENTS CONTAMINATED WITH OIL), *;f4— _ V4 600 w 2. NON RCRA HAZARDOUS WASTE SOLIDS, P 352 c� (f3REhSE), DM 1100 3. 4. 14.Special Handling Instructions and Additional Information TSD:BL 84573290 EC;1 2014 =4H EMERuENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers aggency ori y on ifitial transporter to add or substitute additional transporters on enerator' s behalf. 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national 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 EPA Acknowledgment of Consent. 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 am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name�I n Signature Month Day Year ,j 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: it w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Type Name Signature Month Day Year \ �. IL QTransporter 2 Printed/Typed Name re Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space Quantity Type Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U uQ. Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q1z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. � 2. 3. 4. X132 20.Designated Facility Owner or Operator:Certi ation o receipt of haRrdous materials covered by the manifest except as noted in em 18a 14 Pr ed Name ,, natur Mon` Day Y ar I EPA Fob 4- (Rgvr t�l_,P wious,e�t}onls�ar��psoleltg,-7,�_,; UESNATED FACILITY TO EPA's a MANIFEST SYSTEM