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SSL SK SHIP# 226994004 <br /> 0 0 6 6 8 7 1 1 8 S K S <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number CALOO$358631 2.P 3.Erne nCy Resgr p ne.� 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS 1 tPD a 4 tl 1 h 006687118 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailin Address Generator's Site Address(if different than mailing address) <br /> D & D Lift 1gnc. <br /> 3820 Rhonda Way <br /> TRACY CA 95304-1608 <br /> Generator's Phone: 209-229-7440 <br /> 6.TraosppR f Y—rloan SYSTEMS I NC U.S.EPA ID Number TX ROOOOB 1205 <br /> 7.TraansMpto'rtter 2 CCo�mI'aLn Name U.S.EPA ID Number <br /> CLEAN H�1F�BORS ENVIRONMENTAL SVC INC. MADO3932225O <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 CADO5949431O <br /> 408-441-0962Facility's Phone: <br /> 9, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,ContainT,e <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. <br /> QUO 1. .,' — ...1 r� <br /> C <br /> z 2 NON-RCRA HAZARDOUS WASTE, SOLID 223 <br /> (OIL FILTERS) <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information TSD:SJ 78339574 D 78 CSG: <br /> I t�1� �, j)D <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retains by geTfer toor c refers a arathori y <br /> Dn initial trans orter to add or substitute additional ans orterson eneras behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable internagonal 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 EPAAcknowledgment of Consent. <br /> I cedify that the waste minimization statement identified in 40 GFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quanti )is true. <br /> Genemtorsl0ffemrs PdntedlTypadN e� Signature Month Day Year <br /> .D ilk '2.9 t g <br /> j 16,Interna lona Shipments <br /> ❑Importto U.S. El Expod from U.S. Part of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> Of IT Transporter Acknowledgment of Receipt of Materials <br /> Transporter Printedliyped Name A-NE A��� Signature Month Day Year <br /> a <br /> = Transporter2 PrintedlT �.,. Signature Month Day Year <br /> Z� ' <br /> 1S.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Pull 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 /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Ireatroent,disposal,and recycling systems) <br /> W 1 2. 3. 4. <br /> O <br /> �. <br /> 28.Designated Facilityner or Operator:Certification of receipt azardous materials cov by the manifest except a§toted in tem <br /> PrintedlTyped NameSignafum Month Day <br /> fY <br /> [.J <br /> EPAForm8700-22 Rev.1217�ious edibo re obsolete. DESIG TED FACKri T TO A's e-MANIFEST SYSTEM <br /> 2)7612003/156777 <br />