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^�O SSL SK SHIP# 235956826 IIIIIIIIII'I IIIIIIIIIIII IIII III <br /> Please pnni or type. ,1 ��mm� p Form AppmveB.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Nuesm,lO Numner CAL000394668 2.Pay 10 1_tl#W`-7'4tjpaa1� e.WnXxlTrxklrp NumEer <br /> WASTE MANIFEST l 0 SKS <br /> 5.Nnamor's NmaM ALiI 0.Mreav GdimH,SMLdXes(npRwml Nal rruArq eCYeul <br /> 0 Reilly # 419 <br /> 15079 S Harlan Rd <br /> LATHROP CA 95330-9802 <br /> 209-234-1895 <br /> s <br /> 91M2RffJWSYSTEMS INC U.S.EPAIONelmar TXROOOO81205 <br /> ].Trzrrspmbr 2 Comity Name U.S.EPAIO Numter <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> e.Daeynaled Faulty Nanaa nsMAmla CLEAN HARBORS GRASSY MOUNTAIN us.EPA to Nwnba <br /> 3 MILES EAST, 7 MILES NORTH KNOLLS EXIT 41, OFF 1-80 <br /> KNOLLS , UT 04083 <br /> 435--884-8915KNOLLS <br /> Fail :PNCM. <br /> ya_ 96.U5.DOT OaampOon lmcludirg Rope Bnipprg Name.HamN CWs.lO Numbs, to.Camamme 11.Teal 12.Una 13.Maio Coeee <br /> HM aM PaWy OmuP QlenYll Ne Ty4¢ Oueni W1Nol <br /> P, 1 NON—AGAR HAZRRDOUMUS WWVSTE, SOLID, / DM /� P 381 <br /> o (RBS RBENT ANO OlU, ' <br /> i z I <br /> w <br /> 3 <br /> d <br /> 14s al Hamlinyln�anaMduionalinfo eton TSD:GM 87922994 OR36176 CSG: <br /> ; <br /> \ ON4�S ��s�9 <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by gene r tOr confers agency authorit <br /> on initial transporter to add or substitute additional trans ort ers on generatoras behalf. <br /> 15. GENERATOR'SIOFFEROR'SCERnFIN11011, IM1erebYCetlare Nal Ne mments o1N15 mnsynm¢mare bllyan0 aozrzlmy eescri5ee above by Ne ppper zM1ippng name.eN are daaslfied.peodumd, <br /> madeC and lecelsablarerded aM are rn au rgpeps m propx mlwAm br transpan avddinq b apgkade intemaldalae nebanel gnvemmenpl rvgulauma vagal sM1rymml aM am Ce Pnmvy <br /> I ushm . mhewave :mr—catio orpnsmmgnmenl mnldmb Ne@rms oif Ism a m EPAApmx�M9men1 of fil lYm. <br /> I wNry Incl lnewsde mmimvatipn ahlemem idenllfieCln dG CFR 262 27(a)(e I am a Iarye puanury g¢nerew)or q(AI am a small puanbry peneretwl is Irua. <br /> G /ai011erofs Pnn Ryp Name 5 ` Mont, Dey Year <br /> �' root. L ioI I%I VA 124 <br /> F I6.Inlenaepw151iprnip ❑mPhieUS. <br /> ❑E,pM M1wn U.S. Pal of MMavlrg Sfer"UvS <br /> ? Transitions, XpmMe <br /> Nr s (MaWorla atlyl'. . ' <br /> W 12.TrenspalxAcknee here m Receipt el Mai <br /> T RuMc rt iAE 89reNre Morls NY Year <br /> dI t sa. <br /> 124 <br /> i Tmns 2Prbtee?ypM Name Waite, Ment, oay Yea <br /> 1 le IAsoepenry ~ <br /> I&Deveparm,men.i.Seae ❑ ous" ❑Type ❑geme'e ❑Pamal Releenm ❑Fuu Rea<aon <br /> Manifest Rekrenre Number <br /> 18b.Aaemale Fai forC rai US EPA ID Number <br /> U <br /> LL F.Y.Wa More: <br /> W 18,Strom.of Allemale Fri W Generabrl MmN Day Year <br /> 1Q— <br /> 2 <br /> y19.14aprO}ry Weals R[,QtMapparem lAtllroC CWulle..mb brlmnlMe rtlb bWMaei dNwaN.arc re[KMM aYahrllal <br /> 1. 2. <br /> A.OeslgreleC FadM Oanera0pnabr CatlkabndraxiMdlussrCplN malaiNmwed by tlra rlwlibN eareplas MCCn 10a 2 f �(a� <br /> Premi7mem, Senders, <br /> z <br /> E E1pA)VI2 A -Unious editoras are obsdele. DESIGNATE ACILITY TO EPA's e-MANIFEST SYSTEM <br />