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SSL SK SHIP# 231853957 II�NIIII�III�IIUII��II'�III�If�II <br /> Please print or type. Form Approved.MB No.050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3. m R s e P 4.Manifest Tracking Number <br /> WASTE MANIFEST CRI.000392984 1 '- °1'ga SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> O' Reilly # 32^c2 <br /> La <br /> 1200 W throp Rd <br /> MANTECA CA 95336-9670 <br /> Generators Phone: 209-239-9606 <br /> 6.Trypylpt(pf.Cpmyanylti�atae SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 CompanyNameU.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility,Name and Site Address CLERNHARBORS OF BUTTONWILLOW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> BUTTONWILLOW CA 9320E <br /> 661-762-6200 GRD980675276 <br /> Facilitys Phone' <br /> Sal. 91d.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(d any)) ryp Type Quantity Wt.Nol. <br /> ON—RCRR HAZARDOUS WASTE, SOLID, DM P 181 <br /> 0 (ABSbRBENT AND OIL), -N!74� <br /> (Sk b 1 Lf <br /> 2 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:BL 83671062 OR 10542 (1 I1CSG- <br /> 24H <br /> SG:24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generatoN Mo�N <br /> f�EV lauthori y <br /> on initial transporter to add or substitute additional trans otters on enr' s behalf. <br /> 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, <br /> marked and Iaheledlplaorded,and are in all respects in proper condition for transport according to applicable international and national governmental regulators.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 Consent. <br /> I certify,that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quant y generator)or(b)(if I am a small quanstator)is We. <br /> Gene Offero 'store Print y me ,qp Signatu Month Day Year <br /> ill, A, <br /> 16.International Shipmentsk <br /> r Import to U.S. Ll Export from U.S. Port of enirylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> C17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> C TtanXder 1 Pnntedrryped Name Sign Month Day Year <br /> 0 1�t u bio. a-7 oZ L <br /> Z Transjporter2 Printedffyped Name n tore Month Day Year <br /> F W 7 ` ZD <br /> }. 18.Discrepancy <br /> 19a.Discrepancy Indication Space ❑ Ouantity ❑Type ❑Residue ❑Parnal Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> Isla.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z2 <br /> H19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> H13z <br /> 20.Designated Facility Owner or Operator Cenifcation of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> illl Prin[ed/Typed NameSignature Month Day Year <br /> '� //1�� <br /> EPA Form 8700-22((Rev.12-17 Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)736 N605 <br />