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Ssi SK SHIP* 22&HJ58l!, 11111IIIIII III 1111111111111111111111 <br /> -print or type. V-7 � 0 0 ep^Appr6 5 n eal OMB No.11150-00.79 <br /> UNIFORM MINIFENUIZARDOUS 1-C.emab lD Number CAL000392595 z.'I 1`-7F-4'68- <br /> -7 644'68- 67 0 ,V V TTgJ V q71 <br /> WASTE MANIFEST tlBtltl1100 SKS✓S <br /> 5 G i Name aM Maung Gmms'da Syµy6'(dr5lrgyy yi6 r�irrj'�e-1 <br /> O'' Reilly N 276565 <br /> 430 Cherokee Ln 39-C-02603 <br /> LODI CA 95240-0000 <br /> cereramra Pnare: 209-333-7195 <br /> 6.Tans Refl Com Name US.EPAIDNumber <br /> SA�ETV-KL�EN SYSTEMS INC 7X4000083205 <br /> 7 Tansponer l Company Name US.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> S Desgmdlarl Fermi Name and Site AtlEress CLEAN HARBORS GRASSY MOUNTAIN US.EPA DNumber <br /> 3 MILES EAST, 7 MILES NORTH KNOLLS EXIT 41, OFF I-80 <br /> KNOLLS , UT 84083 <br /> Fadlnya Ftvxe. 435-884-8915 UTI991301748 <br /> go Ed US.OUT Description dedudbg Preat Snipping Name,H'aard CMss,ID Nude',, ta.ConMrtes 11.Fast 12.Una 11 Is Cobea <br /> HM «bpadw9provp(8ing) No. TYW 0--KY 1NNd. <br /> 1 NON-RCRA HAZARDOUS WASTE, SOLID, BM P IBI <br /> (ABSORBENT AND OIL), -11'A <br /> w <br /> :a <br /> 3 <br /> a ti <br /> 14.Sor Hanbrry Instructions and Additional lmamaoon TSD:GM OR14424 CBG: <br /> 24H EMERGENCYM800-468-1760-CH/SK/TFI-Contract retained by geneeraator confers agency authorit <br /> gurnaltsitri into nessals,atirr' s hill <br /> 15. GEXainand 'S'DFFERghadad are <br /> inAibN: InerebdidMar Nt rga olM5¢i soapnlaregataMaSvand Cesm aNametrepoa<rsireadrtme,vtlaradasvkd. , <br /> marled and IabeleNplacaNed,and as In all respells In proper rmdlM1on tar VanspaR acceNing W appliwde Inlemallpneland nallonal goremmenal regulations.NeapaR ahipmenl afA I am NB Primary <br /> Eapaner, reNYylnal Me wnlenl5 p(Mrs anspnmenl cwlbrm to Me terms of Ma albcMb EPggdrgwladgment of Covent <br /> I mN1y Mal Vz waste mmimfla0m ffilerllenl tlenLlad in d0 CFfl Zfit zi1a141I am a Iarye 9uenpTy plreab w Idl pl l am a small ouanYry generebrl is bUe. <br /> GratoJ ; unlddT NNdrod SigaN <br /> nwV re <br /> 8 <br /> ill <br /> is Mlemntran,ignore" ❑Impppb U.S. ❑EWRhwnLLS. a'arr'str _ _ <br /> ? Tamparleraiinabre lbrmi only) one leaving LLS.: <br /> ad 17.Tansgrrle'Phvpnlel]mental Resglar Metewh <br /> Tan V v\ saris MprrOr Yar <br /> d <br /> 2 T 1Fd yped Name squaNre M«M paY Vw <br /> I10.Da«6anry <br /> 18,Dw pm IrM p- ❑ DuantiN ❑Tpe ❑pats Raeca«I Ll Flat Relasson <br /> Mar Federal Numb«. <br /> 1" <br /> .ever Fapliry I«Cereralorl U.S EPA I)Number <br /> U <br /> u FadNyeturn¢. <br /> t&.Sgwture plAeemate Faaf8y l«Ge-mal <br /> :SA Y <br /> as 19.Xamlds WmMR68 Marr6erron MelMq Cotl"Ile..6desb MUNvu wwk beabrarrl d6ma,am rer.N]rg syansl <br /> a. <br /> 0 1. z. a. <br /> m.p®TaW Fiyl7owrar«opefaM cwerl®ml draxManmlmrsrrerummem br uc manual n®Nxmed in lmm tea <br /> 1 rlMeb ypeE Nana SigneareMonts ay ear <br /> Z ZZ <br /> Ei�73G8i1 (� 752��t' Bod"mus maws are o0.wkle. E NATE ILITV TO EPA's e-MANIFEST SYSTEM <br />