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SSL SK SHIP# 228417809 a 1111 <br /> CC ` 9E1Qi6i14i <br /> Form Approved.OMB No.2050-0039 <br /> Please print or type. 2.Page 1 of 3. me RGs o7se Ph 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000425303 1 1 —`}�a-1� 0 006961076 SKS <br /> WASTE MANIFEST <br /> d Mailing Address <br /> Generators Site Adtlress I.different than mailing atldross) <br /> 5.Generator's Name an <br /> Garel Trucking/Classi.c Sales In <br /> 2577 W Yo Mite Ave <br /> MANTECta CA 95337-9641 <br /> Generators Phone. X09-249-3204 U.S.EPA ID Number <br /> 6.Trg5p➢[t6rJV_TnY SYSTEMS INC TXR000081205 <br /> ViFt Y Y�L U.S.EPA ID Number <br /> 7.Transporter 2 Company Name MAD0393222 50 <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. <br /> U.S.EPA ID Number <br /> 8,Designated Fac lity Name and Site Address CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD CA 35133 <br /> SAN JOSE CAD059494310 <br /> 408-441-0962 <br /> Facility's Phone <br /> 10.Containers Total 12.Unit 13.Waste Codes <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No Type Quantity Wt.Nol. <br /> HM and Packing Group(if any)) <br /> DM P 223 <br /> 1. NON-RCRA HAZARDOUS WASTE, SOLID <br /> o (0-11- FILTERS) <br /> Z 2. <br /> w <br /> t7 <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information TSD:SJ 7981Q1530 GA15065 CSG 7 <br /> authori y <br /> 24H EMERGENCY#800-468-1760-CHISK/TFI-Contract retained by gener or confers a ency <br /> I <br /> 5 makedandabellOFFEROR and alrelm allOrespec4sr'm properacondtion for tmnspod aocodng90 applicable ilntemational andy aetional govemmenUl regulaonsl Rpexporl ship mnt and l am are the Primaryd <br /> card <br /> Exporter,I certify that the contents of this consignment wnform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify,that the waste minimization statement idenflFled in 40 CFR 28227(a)(if am a large quantity SignaNre or(h)Qf am a small quantity generator)is true. Month Day Year <br /> Generatorsl0fler�edfryped Name l <br /> /l <br /> 16.Intemationa remnants Import to U.S. ❑Exportfrom U. . Port of entry/exit'. <br /> Dale leaving U.S.: <br /> ? Transporter signature(for exports only). <br /> W 17.Transporter Acknowledgment of Receipt of Materials Signa Month Day Year <br /> KTr Order 1 PdntedlTyped N �r �� 11ar <br /> p 'Lh y W Month Day YeaL <br /> a r <br /> N 2 Prin eLliry/p�ed Name <br /> 18.Discrepancy ❑ <br /> 1 El Type <br /> ❑Residue ❑Partial Rejection Full Rejection <br /> I <br /> 18a.Discrepancy Indication Space � Quantity <br /> Manifest Reference Numher. <br /> US.EPA ID Number <br /> � 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> ar <br /> FacilityPhone, <br /> PhonMonth Day Ye <br /> W 18c,signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> y <br /> disp <br /> 19za <br /> .Hardous Waste Repod Manage ant Method Codes(i.e.,mdes far hazardous waste treatment, 3sal,and recycling systems <br /> 4 <br /> w , L 2. <br /> G <br /> 20.Designated Facility w er Op tor.Cedil n of re if o azardous materials covered by the manifestexceptas noted in <br /> h e <br /> 1 Printedlryped Name <br /> DESIGNATED FACILITY TO EPA's e•MA FEST SYS EM <br /> EPAForm <br /> 61003R )/156777eviousediton are — <br />