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- ;!.. SK SHIP# 230525264 (I'I��II I�II'lli��IIII�II�I�IIII��II) <br /> 0072752905 KS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. meecX Rrspgrise Pho,e_ _ 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> ' 1007275290 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Herc Rentals Inc <br /> 11285 Vallejo Ct <br /> FRI't`rP CAMP CA 95231-9772 <br /> Generator's Phone: 209-982-9670 <br /> s.Tr�QSpplfet f G-Mp�y��[Qr; SYSTEMS INC U.S.EPA ID Number r v 80000812'05 <br /> 7.Transporter t2 Company Name U.S.EPA ID Number <br /> HARBOR" ENV SVC INC. MAU039322250 <br /> 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONW I LLOW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> RIITT!�NW I LL-OW , CA 9320E, <br /> CAD980675276 <br /> 661-762-6200 <br /> Facility's Phone: <br /> ga 9b.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 Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON RCRA HAZARDOUS WASTE aOLIDS, - <br /> O (DEBRIS, PETROLEUM HYDROCARBONS:: ` <br /> Z 2. <br /> w <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD BL 82[29842 HE24693 <br /> ) <br /> 24H EMERGENCY#BOLA-468-17FO--CH/SK/TFI-Contract retained by generator <br /> rri initial tran,riorter to ;-dd nr substitute adrllitio-=ll tran-vorters n n� <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 labeled/placarded,and are in all respects in proper condition for transport according to applicable intemabonal 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 /> 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. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> 16.International Shipments <br /> F- ❑Impo o U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Tr orter 1 Printed/Typed Name n Month Day Year <br /> O x <br /> i V <br /> Z Transporter 2 PrintedFFyped Name III Si ature Month Day Year <br /> --5/ 4 c7Z oG zv <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantityyp <br /> ElT e El Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> rai Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazarclov Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated cil' Owner or Operator:Certification of ceipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/T p a Signature Mont Da <br /> y � y Z01 <br /> EPA Form 8700-22(Rev.12-17) Previ s editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />