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SSL SK SHIP. 234010405 111111IIIIIIIIIIIII1111111ITIIIIIII <br /> 0079 a 3 a 11 s K s <br /> Please print or type. Page Form Approved.OMB No,20500039 <br /> UNIFORM R ROOUS I.General to Numbarr CAL000393245 2. yld 31EmKr�yry Rewgne PpcgeO I.ManHeu Trxhlrp NumEer <br /> WASTE MANIFEST CION 46C 17b 007983811 SKS <br /> 5.Gri 1,rs Name and Mailing Addi General 9b Pddraas III Savant Nan mailing atlEral <br /> O' Reilly # 3477 <br /> 420 W Lodi Ave <br /> LODI CA 95240-3423 <br /> Gm,eawraP e: 209-369-1988 <br /> s.W?eri SYSTEMS INC us.EPA ID Warren T%R000081205 <br /> 7.Trempwwr2 Company Nene U S EPAIU NIndil <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> e.EvagoaMd Fammy Nemeagal Sb Andrea CLEANHARBORS OF BUTTONWILLOW US.FPA ID Nummr <br /> 2500 LOKERN ROAD <br /> BUTTONWILLOW , CA 93206 <br /> Fa<m '.PM1nne: <br /> 661-762-6200 CAD980675276 <br /> ga. 9b.US.DOT Dwlpliw l'aldldai9 Fmpe Shipping Name.Hazed Claaz.ID Nundtt. 10 comlairam 11 Trial 12 UrN 13.NaaM Codes <br /> m aMPa%eg GlvupotalY➢ rvo. Tlce ouaft* 'MNa. <br /> APB NONTRACRA ND HAZOILARDOUS WASTE, SOLID, I DM I P 181 <br /> Mg <br /> Mg 2. <br /> w <br /> u <br /> 3. <br /> 4 <br /> 14 Speoal HaMlir Insbnwmamemmmmnmrmnim TSD:BL 85853585 OR14435 CSL': <br /> 24H EMERGENCVN800-468-1760—CH/SK/TFI—Contract retained by gene or c"infers agency arathori y <br /> on initial transporter to add or substitute additional an15 GEMEMTGP'yGFFENGN'3 CERIIMATpX: InarepY de6velNl Meonblbd111¢taragmlynrare NNy aN aSna@il'deSvi[ed aama EY b'a Vd'e. rN{p^9^enc.aN aretlasaFM. . <br /> mal and NEeled/platsNM,and are in all marn5in mria,gndiial Ior1ranspnl aanNllg bapNiable IMBmaM1malBN ndAMlel gawma lal regulaAons.Ila4yrl abrin l and I am Ne Enmary <br /> Eaponar.l arlfy Mel Me mnlenh of mk mnsgnmenl mMwm to IM1e terms dwa alaclred EPAP Amwletlgmenl of Conaenl. <br /> I arUty Mat Me waft minim¢aMm zwMrrenl idenYfiM In W CFR 1fi11]ta)tit I am a large quarilrygewabr a Ibl fill I quen9y geieawr)is true. <br /> GehnwlsrOEeMs pm , Na /Sgradvap <br /> � n Y <br /> � l7z <br /> 'E.Imemelwa Np mponb U.S. ❑Eapar M1an U.S. madidanby/eM'. <br /> TraNpMer yyubra Ila dimal mhl Dalt"US.: <br /> K 17.TaroponwAdagwb'ymznrol Rampld Metr aN <br /> pTRns IFlinled? Sgnaggral Mal peY Ywr <br /> 's a <br /> QTareporle2 YpM Name MomM1 Day Y. <br /> i1e.DIfwewrwv <br /> 18a IlrsaepamylMaEon Spare ❑ plognlry ❑Trye ❑Rndue ❑ ❑Ed'R <br /> eleptpn <br /> Merrill Referenre Number: <br /> 180.Ademale Faddy(w Gererarw) U.S EPAIDNMrLer <br /> U <br /> u FacilAy'z Phom <br /> drawn,ofAlwmale Fadlltylw GeMmwrl Ml pay Year <br /> S <br /> 19.Hezede.¢Wen RepM MaragemenlMdMd Codes ti e.,mdesM M1aaamgus wash ueamrent Orspoal,aM aclrlmp syMenn) <br /> C 1 4. <br /> 20.ANgnalel FmMy OwnawOpeaW:Lelfo dreaipldbvedous mweredMme rrvYbMehagaz Metl m Ileo lBa <br /> Pentad Name yla Mpatla pay Year <br /> 1141 bjy;�K <br /> EPA MBI 102`774175171 Prevpus ns are desdele. a DESIGNATED FACILITY TO EPA's e•MA�/NNII/FE(STTISYSTEM <br />