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SSL SK SHIP# 230525229 111111111111 I�II��IIIit1 <br /> 007275291SKS <br /> Please pont or type. Form Approved.OMB No.2050 0039 <br /> t.Generator ID Number Z Page t of 3.Eme�ency Resrse Phone -4.Madrfesl TrackNumber <br /> UNIFORM HAZARDOUS CAL0003,,8631 1 1-1i0t11'4h8-176QI 00 7215291 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generator's Site Address(if diterent gran mailing address) <br /> D & D Lift Inc. <br /> 3820 Rhonda Way <br /> TRACY CA 5534-16@$ <br /> Generators Phone: 209-229-7440 <br /> 6.Trans der 1 Com ny Name U.S.EPA ID Number <br /> SNFETY-rLEEN SYSTEMS INC TYRL400081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> FadlWs Phone: - <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 71.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WiNol. <br /> 1. NON RCRA HAZARDOUS WASTE SOLIDS DM P 223 <br /> o (DEBRIS, PETROLEUM HYDROCARBONS <br /> 3 y <br /> w 2. NON—RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> (OIL FILTERS) <br /> 150 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:SJ 82229537 DD0278:i =a CSG: - - <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator.v nfers agency alathori y <br /> initialon { R <br /> 15. GENERATOWS10FFEROR'S CMIF1CATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dadi <br /> ased,packaged, <br /> marked and labeledlplacartled,and are in all respects 0 proper condition for transport according to applicable international and national governmental regulalions.If export shipment and I am the Primary <br /> Exporter,I certify That the contents of this.cortsignmenl conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that Me waste minimization statement identified in 40 CFR 262.27(a)(111 am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> r3 Printad/Typed Name - Signature Month Day Year <br /> Is.International Shipments <br /> F ❑Import to U.S. ❑Expod from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports onlg): - Date leaving U.S.: <br /> W 17.Transporter AcknoWedgment of Receipt of Materials <br /> r t PdntedfT me - 'nolo _ Month Day Year <br /> 1 I ZI I zo <br /> _ ransporter 2 PrintedlTyped Name re Month Day Year <br /> r <br /> tie.Discrepancy - <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F 78b.Ntemate Facility(or Generator) U.S.EPA ID Number <br /> 3 <br /> U <br /> Facility's Phone: <br /> 18c.Signature of..me.Facility(or Generator) - Month Day Year <br /> Q <br /> 2 <br /> % 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 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 t Be <br /> Printedrfyped.Nam .Signature Month Day Year <br /> EPA Form 8700-22 fRev.12-17)Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)8005834/1506536 2)7612003/156777 <br />