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SSL SK SHIP# 226191284 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter-) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Erne n Res rise Ph 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000358F31 1 -e" �-10 011844699 FLE <br /> 5,Generator's Name and Mailing Address : Generato,s Site Address(if different than mailing address) <br /> D S D Lift Inc. <br /> 3820 (Rhonda Way <br /> TRACY CA 95304--1608 <br /> Generator's Phone: 209-229--7440 <br /> 6.Transporter 1 Company me U.S. PA ID Number <br /> 5AFETY—KLEEN <br /> SYSINC TXRA000B3205 <br /> 7.Transporter 2 Company Name U:S.EPA 0 Number - <br /> CLEAN HARBORS ENV!RONMENTAL SVC INC. HADM393222510 <br /> 8,Designated Facility Name and Site Address CLEAN HARBORS 544N JOSE U.S.EPA 0 Number i <br /> 10?1 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAM9494310 <br /> Fadlity's Phone: <br /> ga. 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.Nol. <br /> 1' NON RCRA HA7ARDCIU& WASTE SOLIDS A� DN 1460 P 2231 <br /> or (DEBRIS, PETROLEOM HYDROCARBONS( — <br /> 4a 1 <br /> z. NON—RCRA HA7.ANDOLM WASTE, SOLID / DM 7- 5 U P 223; j <br /> (OIL FILTERS) <br /> 3. <br /> x, <br /> 4. <br /> 3 I <br /> 14.Special Handling Instructions anclAdditional Information TSD.SJ 77629384 DD02763 CSS: <br /> 24H EMERCir--NCY*800-468--1760--CH;SK/7E'I•-Contract retained byiti 1-agenerator confers a enauthoan in to add or subsititate additinnal t ri y <br /> f. <br /> 15. GENERATOR'fiFERURB 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 labelediplacarded,and are in all respects in proper condition for transport aoDvding 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 W 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)(if I am a small quantity generator)is true. <br /> eneratorslOaeni PrinkdrrypedNarae igna re on a Year <br /> V f ler !3 C-% / <br /> 16.international Shipments <br /> r Import to U.S. ❑Export from U.S. '--'Pon of entry/exit: <br /> Transporter s nature for exportsoni Date leaving U.S.: <br /> W 17.Tmnsporler Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Aln ay Year <br /> a ,SK,%'q.N(` r4(,[f J�J �J <br /> i Trans 2 Pdntad Typed Name Signature"-2 1 onth Day Year <br /> 18.Discrepancy - <br /> 18a.Discrepancy Indication Space ❑ Quantity []Type ❑Residue ❑Partial Rejection ❑Full Rejaion <br /> Manifest Reference Number. <br /> 8b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> W 18c.Sgnature of Alternate Facility(or Generator) - Month Day Year <br /> zz <br /> W <br /> 19.Hazardous W to Repod Management Method Codes(i.e.,cod for hazar ous waste treatment,disposal,and recycling systems) <br /> G.1, 2. 3. 4. _ <br /> 20.Designated Facility or Operator Ce icaifon of re of hazardous materials covered by the manifest except as no 18a - <br /> PdnledlTypedName - SignaWre tM ` <br /> V1 �u t <br /> EPA Form 8700-22 �'evious edillons are o ete. DESIGNATED FACILITY TO GENERATOR STAT (IF REQUIRED) <br /> 1!90058341 536 2)7612 /15-6777 <br />