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SSL SK SHIP# 228694392 <br /> Please print or type. 006960331 SKSForm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2. i 3.E-e = ��e 1'' �® 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000425303 1 � <br /> 1006960331 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Gardner Trucking/Classic Sales In <br /> ' M77 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 209-249-3204 <br /> 6.SFfFETY KL9 SYSTEMS INC us.EPA ID Number <br /> TXR000081205 <br /> 7.Transports-2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designate<Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> Facility's Phone: SAN JOSE , CA 95133 <br /> 408-441-8%2 CAD059494310 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12,NoType Unit <br /> HM and Packing Group(it ani Quantity WLNo1. 13.Waste Codes <br /> , <br /> 1. NON—RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> of (OIL FILTERS) <br /> 9 <br /> w <br /> 2 2. <br /> w <br /> 0 <br /> 3 <br /> 4 =rf: <br /> ¢ . <br /> 14.Special Handling Instructions and Additional information TSD:SJ 80157797 BA15065 S• <br /> gaon 0 <br /> 24H EMERGENCY#800-468-1760—CH/SKITFI—Contract retained 6y generator con rs a ency authon initial transporter to add or substitute additional transporters an ra or's be ra y- <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 international and national governmental regulations.Ifexport shipment and I ami Primary , f <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent ..:�` <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(ill am a small quantitygenera is We. <br /> Generators ferors Pdnte fTyDed Name Signator .,;ASN Day Year <br /> „ � 0 <br /> 16.International Shipr <br /> i— ❑Import to U.S. ❑Export from U. ort of entry/exit: <br /> ? Transporter signature(for exports only): Dat leaving U.S.: <br /> rY 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Tmnsporter\rinted/Typed Nage Signature Montfi" Day.,, Year <br /> M Transporter 2 Printed Name Signature <br /> R' .'. ... OeY. Year <br /> j18.Discrepancy <br /> 18a.Discreparcy Indication Space L11 <br /> Quantity ❑Type ❑Residue ❑Parfial Rejecton iJE]_I Full Rejection <br /> Manliest Reference Number' <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> iva Facility's Phone: -- - ' <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year { <br /> y 19.Hazardous Waste Repi nagmr ent Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems)1. <br /> ' <br /> 2. 3. 4. <br /> 1414 <br /> 20.Designated Facility 0 to for unification f receip o c ous materials covered by the manbest except as'VeqjWknn7a <br /> Prin[edlTyped IJame ` Signature M x <br /> DINC <br /> EPA Form 8700-22(Rev 12-1 to edi Ions s DESIGNATED FACILITY TO EPA's e-MANIFESTSY9TffM <br /> 1)7612003/1567 7 < <br />