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..,.:L Q SK SHIP# 230934!57 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergent Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> CG11 00PJ�+4fsfi(�? ? 1-(3td i-468-17601007439050 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> . Cheena Frei ght l i.nes LL.0 <br /> 1621BO S. McKinley Ave <br /> LATHROP CA 953 30--(A IZ <br /> Generator's Phone: 209-999-0777 <br /> 6.Tr?nsporter 1 Com an N Jn U.S.EPA ID Number <br /> >iaF r Ta- I, SYSTEMS INC TXR000061205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBCIRS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN MSE U.S.EPA ID Number <br /> 11321 BERRYESSA ROAD <br /> SAN JOSE LA 551:,3 <br /> 408--441--0'3; : CAT)059494:310 <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 <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> N(1N RCRA HAZARDOUS WASTE SOLIDS, F} ;i15),2 <br /> of (OIL.*, D I RI AND SAND), -W4- <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information T SI) ES J 826 13050 U146348 CSCE Y <br /> 24H EMS'RGENCY#800--'458-t7C,@--CH/5K/TR'I-Contr,act retained by generator confers 1, eauthor . <br /> .� ., cap +. r. <br /> 15. GENERATOR'SIOFFEROR'S CE TiFICATION: 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.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 /> Generplor$IOfferor's Printed/Typed Name Signature Month Day Year <br /> J 16.International Shipments <br /> iL_ ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of MaterialsLLI <br /> _ <br /> Tfansp r 1 PrintedlTyped Name J SignatureMonth Day Year <br /> a, ?.✓ - �" 1'jar `f` r- , ! r , Mfr <br /> Z nsporter 2 PrintedName Month Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ QuantityType❑ yp ❑Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> M 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � <br /> 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 /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> 1)8811015/1985944 <br />