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SSL SK SHIP# 228417803 IIIIII�IIIIII IIBInoil III III <br /> Please print or type. 0 0 6 9 b 1 0 7 5 5 K S <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me n R s nse"006961075 <br /> h 4.Manifest Tracking Numher <br /> WASTE MANIFEST CAL000425303 -e`°��'- �8-1y'g0 0 96 0 SKS <br /> 5.Generator's Name and Mailing Address Genemtars Site Address(if different than mailing address) <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 209-249-3204 <br /> 6.Tr9KF0 ETY m�(99n1 SYSTEMS INC U.S.EPA M Number <br /> H TXR000081205 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 SE CARPENTER DR <br /> Facility's Phone: CLACKAMAS , OR 97015-8988 <br /> 503-788-4616 ORQ000025197 <br /> 91 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Packing Group(@any)) No. Type Quantity Wt./vo.. 13.Waste Codes <br /> o (DRAINED/UNDRAINED WASTEOUS SOLID P <br /> NED/UNDRAINED USEDbILFILLTERS) DM 223 <br /> Z 2. <br /> W <br /> 0 <br /> 3. <br /> 4, <br /> 1 L <br /> 14.Special Handlinglnshuctions and Additional Intonation TSD:TPO 79810530 GA 15065 CSG: <br /> �,aai 0 <br /> 1 � <br /> G��{� <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by geher` Cor confers aon initial transporter to add or Substitute addition I transporter, an nenera ency alathori y <br /> nrl � behalf- <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 Iabeledlplacanded,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 EPAAcknowledgment 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)(dl am a small quantity generator)is hue. <br /> Generetors/Offerors Printed/Typed Name Signature Month Day Year <br /> 1 19J 16.International Shipments S I N <br /> F ❑Import 10 U.S. ❑Exportm Port ofentry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter AcknoWedgmentof Receiptof Materials <br /> OT sporteri Pnntedlfy Name Signature Month Day Year <br /> Z her 2 Pn /Fyped Name ignature Month Day Year <br /> } 8.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity E—]Type ❑Residue ❑PaNal Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 189.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> < Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except in Item 1 a <br /> PrintedlTyped Na SignaNre Month Day Year <br /> 1A JU fL"VL <br /> EPA Form 8700-22(Rev. 2-1 Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)7872679/156033 <br />