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SS!._ SK SHIM'## 232747750 (I�II�IIIIIII'II�'I�IIIIIIIIIIlI��I�) <br /> 0077718458 KS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number o r 12.Page,1 of 3.jme � Rprspop�se P,ho�g 4.Manifest TrackiNumber <br /> CAI_0003929,�} �.--}t,:::-; 1007711845 SKS <br /> WASTE MANIFEST <br /> 5.Generator's Nameand Mailin Address Generator's Site Address(if different than mailing address) <br /> 01 Re 1 11- # '?i=u <br /> 1200 W Lathrop Rd <br /> MANTECA CA 95336-9670 <br /> Generator's Phone: <br /> 6.Trgispp[ter�cVorr�pAnvName SYSTEMS INC U.S.EPA ID Number TXR00t0081205 <br /> 7.TranFstptortter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONW I LL_OW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> BUTTONWILL.OW , CA ` 3206 <br /> 66 t-762-6200 CIAD9801575?76 <br /> Facility's Phone: <br /> 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing roup(if any)) No. Type Quantity Wt.Nol. <br /> IX 1 'Nf5I4E- NON-RCRA HAZARDOUS WASTE, SOLID, i { P 1Pt I <br /> 0 (ABSbRBENT AND OIL), td - <br /> � <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:BL 84632212 OR 10542 <br /> �'do 'z( 2- 'j . <br /> 24H EMERGENCY#8010-468-1760--CH/SK/TFI-Contract retained by generator confers a ency authori y <br /> on initial transporter to add or substitute additional transporters on enera or' s behalf. <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity genera or(b)(if I a'R a small clantil generator)is true. <br /> Ge ator's/Offeror's anted d Name Sign ure Month Day Year <br /> 6 I t v 1 `11:1 <br /> 16.International Shipments <br /> P- ❑Import to U.S. Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 0: 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> Tr sporter 1 Printed/Typec <br /> ma Sign Month Day Year <br /> nIL w.d�o,n �:�- Its <br /> y p <br /> Z Transporter 2 Printed/Typed Name nature Month Day Year <br /> Lit oy ZJ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type El Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19. azardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.D signated Facility Owner or Operator:C 'ication of receipt of h zardous materials covered by the manifest except as noted in Item 18a go <br /> 1dNMonth Dq1)] <br /> 1 <br /> EPJ F �j{y�7ny0?�21Re�v ,1y,�1f rr Lnus editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> r JD L t:J t /4VJIJIJ O .J <br />