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SSL f SK SHIP# li l lllll!!llll ll IfilE l INIII <br /> `Please print or typed2,5r J ll 0% Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pa of 3. m R s e P 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> �'° � 10 006687804 SKS <br /> b.Generator's Name and Mallin Address Generator's Site Address(if different than mailing address) <br /> Autozone # 5g685 Autozone # 5585 <br /> 123 South Front Street 8228.West.; Ln <br /> IMEMPHIS TN 38103 <br /> Generator's Phone: 209-957-1108 ST.OWTON, CA 95210-3148 <br /> SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Cam an Name U.S.EPA ID Number <br /> CLEAN 4KW1©RS ENVIRONMENTAL SVC INC. VAD039322250 <br /> 8.Designated facility Name and Site Address <br /> CLEAN HARBORS ENVIRI7NMENTAL SERVICES, IN U.S.EPA ID Number <br /> 2247 S HIGHWAY 71 <br /> KIM , NE 69145 <br /> 308--235-4012 NED981723513 <br /> Facili 's Phone: <br /> 9b.U.S.DCT Descr lion(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> 9a. P� (� g P Pp 9 11,Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No Type Quantity Wt.Nol. <br /> X 1. RG UN 1993 WASTE FLAMMABLE LIQUIDS L � DMI P F001 Ill F003 <br /> o N.b.S. , (XkENES, BENZENE), 39 PG Il <br /> (I}0011 <br /> Fill DI 223 <br /> z 2. <br /> LU <br /> 3, <br /> 4. <br /> 14,Special Handling instructions and Additional Information TSD-.KP 78578852 AU31470 crSss <br /> 1)ERG#128. 1 " —ywot V d5 <br /> 24H EMERUNCY#800-468--1760-CH/SK/TFI-Contract retained by generator confers aency authoIl y <br /> on initial transporter to add or substitute additional transporters on enera?or'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 classed,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 axporl 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 /> I certify that the waste minimization statement identified in 40 CFR 21{if I am a large quantity generator)or(b)(if i am a sma amity generator)is true. <br /> ARQ <br /> ZoratorsiOfferors PrintedlT ped Name Signature Month Day Year <br /> 3 l� <br /> 16.Inte onai Shipcots <br /> i ❑Import to U.S. ❑Export from S. P entryfexit: <br /> 9 Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> Trans orter 1 Printed/Typed Name Sig tur Month Day Year <br /> e <br /> f.LBle 1 z r r <br /> Z Transporter 2 Printed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Ll 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dispesal,and recycling systems) <br /> � 1, 2. 3. 74- <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest exce s noted in Item 18a <br /> Printed/Typed Name Signal Month y Y <br /> EPAFr $IDp_HA.12; iI,90us editions are obsolete. DESIGNATED FACILITY 0 A's e-MANIFEST SYSTEM <br />