Laserfiche WebLink
SSL SK SHIP# 228243205 <br /> r <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number 2.Page 1 of 3.Eponse Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS CAL00015202 A IT-41-468-t760 <br /> WASTE MANIFEST 1007040375 <br /> SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 3C Trucking Inc <br /> 1415 W. Anderson St. <br /> STOCKTON CA 95206-0000 <br /> Generator's Phone: 209-466--3282 <br /> 6.Tr ns orter 1 Com ny Name U.S.EPA ID Number <br /> IAFETY-T9 E:EN SYSTEMS INC . TXR000081i?%35 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS E.NV I RONMENTAL. SVC INC, MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE. U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-1CAD0594943 10 <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(ff any)) No. Type Quantity Wt./Vol. <br /> X 1. NA3082, HAZARD-1-11;5 WASTE LIQUIDS . DM r P M0 D008 213 <br /> o N.0 SR (PETROLEUM DISTILLATES LEAD) <br /> 9, PM III f <br /> Z 2. <br /> LU <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSDv SJ 79814127 3010836 CSS: <br /> i)ER171 <br /> 24H EMER69NCY#800-468-1760- /SK/TFF-Contract retained by generator conferAsa ency autheri y <br /> on initial transporter to add or substitute addition? r r. °f � <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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international 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 /> p t <br /> j 16.International Shipments <br /> 1= ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgment of Receipt of Materials F 1 <br /> Transporter 1 Printed/Typed Name Signaturef Month Day Year <br /> �)g �/.S�rr�}f�r�/r! <br /> ZTransporter 2 Pn ted/Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ ❑ ❑Full Rejection <br /> El Residue Partial Rejection j <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> u< Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1• 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22Rev.12-17 Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> 1)8600871/1827950 <br />