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SS!. SK SHIP# 229209533 IIIIIIINiNiiN�nl�ll�tl��llll l <br /> Please print or type. GCT 1 Form Approved2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me�q�ryy Ryspo�Ise Pl 4.Manifest Tracking Number <br /> WASTE MANIFEST CflL00Qt425303 1 IitO1C1-4btl-1!b0 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) �71� <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators 1�PhonQeo: y209-249-3204 <br /> 6.Tr� to"Mi,ir"ttd SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name LLS EPA ID Number <br /> B.Designated Facility Name and Site Address EAN HARE S SAN JOSE s.EPA ID Number <br /> 1021 bERRYESSA ROAD <br /> Facility's Phone: SAN JOSE , CR 95133 <br /> 408-441-0962 CAD059494310 <br /> 9a 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(if any)) No. Type Quantity Wt.1vol. <br /> NUN—RCRA HA7ARDOUS WASTE, `iOLID DM P 223 <br /> o WIL FILTERS) / <br /> qQ C� <br /> z 2. <br /> W <br /> CD <br /> 3. v <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:S7 8079$636 GA 1506 <br /> 24H EtIERGENCY#800-468-1760—CHISKITFI—Contract retained by generator confers a encnn inifiAl transporter to add Or substitute additional rann �,ye, authori y <br /> he Lf� <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are c(essifietl,packaged, <br /> marked and labeled/placarded,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 germina )or(b)(if I am a small ti generator)is true. <br /> Generator./Offerors Printgyped Name Signature Month Day Year <br /> a leX 1`m�^t 2 f� 2, <br /> 16.International Shipments <br /> p_ ❑Import to U.S. ❑aped from U.S. Port of entry/exit <br /> EGTransporter signature(for exports only): Date leavin U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 1- Transpqrper I PnntedRyp Na Signature Month Day Year <br /> a 106 1.4, <br /> = Transporter nntedlT ame Signature Month Day Y r <br /> 2 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pardel Rejection ❑Full Rejection <br /> Manifest Reference Number: j <br /> 181h.Alternate Fadlity(or Generator) - U.S.EPA ID Number <br /> J <br /> V , <br /> LL Facilitys Phone: <br /> W 18c.Signature ofAltemate Fadllly(or Generator) Month Day Year ' <br /> Q <br /> z <br /> h19.Hazardous Waste jw4rizMenaperpend Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> 20.Designated Fadli Ope tor. 4 dification i ipt of hazardous materials covered by the manifest except as noted in <br /> Printed/Typed Name Signature D <br /> AkAl <br /> EPA) l61T %%fl1l.J- 17 evious editio etb DESIGNATED FACILITY TO EPA's e-MAN1FE9T SYSTEM <br />