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SK SHIP# 232688759 0 0 7 7 7 0 1 6 4 S K S Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS1.Generator ID Number 2.Page�1 of 3.knnpj Res__Nse. 14.Manifest Tracking Number CAR�D@0039370 ,-., ?Pf-,0_ �" . 007770164 SKS WASTE MANIFEST 5.G erator'spame ar�Mailing Address Generator's Site Address(if different than mailing address) °sc=a on remier Brands Inc. 1905 Mchenry Ave ESCALON CA 95320-0000 Generator's Phone: 09-552-6051 6.'MFt f9QnnftR SYSTEMS INC .� 10;. 1.7,`. U.S.EPA ID Number -E�f.`s. �. �- .;�,, 1.Trn p %2Com a U.S.EPA ID Number L tt [-9t�� RS ENV SVC IN€. 8.Designated Facility Name and Site Address CLEAN HARBORS DEER TRAIL, LLC U.S.EPA ID Number 108555 E HIGHWAY 36 DEER TRAIL , CO 80105 C_ 970-386-229� 9D 9I 30 ,t 8 Facility's Phone: 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Vol. 1. NA,3082, HAZARDOUS WASTE, LICaliID, �' P DOI1 o 3`- N.0.S. , (SILVER), 9, PG ?� y ch tlp z 2. L 3. 4. 14.Special Handling Instructions and Additional Information T; D r DR 84573290 ES 12014 1)ERG#171• 01�qRtD 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers ar�envy authority on initial transporter to add or substitute additional transporters on enera or' s behalf., 15. GENERATOR'SIOFFEROR'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 a a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature I /] Month Day Year Wit/ J 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: IX w 17.Transporter Acknowledgment of Receipt of Materials Tr nsporter 1 Printed/Type d ame Signal Month Day Year aII1J z Transp2N 2 Printed/Typed Name nature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z F) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature onth Day Year m (n rYla 0& I- IPtA F , �Zj;P411 i us editions are obsolete. DESI N TED FACILITY T E s e-MANIFEST SYSTEM J , .. ��i3 .