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SSL SK SHIFT# 23094411.9 II�III�Ifl�in���INI11I�ll�l��l <br /> 007439151SKS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID NumberNry •-- - 2.Page t of 1 3.Eme en Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000358631 1 1- t'1 -468-1760 1007439151 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> D R D Lift Inc. <br /> .3820 Rhonda Way <br /> TRACY CA 95304-15013 <br /> Generators Phone: 209-229 '7440 1`J <br /> 6.Tran der 1 Com any Name - U.S.EPA ID Number <br /> Two <br /> SYSTEMS INC TXR0OOO81205 <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 IO Number <br /> 1021 BERRYE'SSA ROAD <br /> SAN JOSE , CA 95133 <br /> Facility's Phone: 408-441-0962 CAD059494310 <br /> ga. 91b.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)) <br /> No. -Type - Quantity Wt.Nol. <br /> 0 1. NON RCRA HAZARDOUS WASTE SOLIDS DM P 223 <br /> F (DEBRIS, PETROLEUM HYDROCARBONS <br /> Lu <br /> z. NON-RCRA HAZARDOUS WASTE, SOLID DM P 2.23 <br /> (OIL FILTERS) <br /> 1 )50 <br /> 3. <br /> 4. <br /> i . <br /> 14.Special Handling Instructions and Additional Information TSD .I 8P522442 DD02 7A3 <br /> a. <br /> 24H EMERGERICY1d-468-1700-CHlSK/TFI-Contract retain Pc+ by genaratnra f. s pn'y atithori y <br /> 15. GENERATOR'SIOFFEROR'S.0 M IFIGATION:I hereby declare that the contents of this consignment are fully and accurately described above by the PmK,.. g name,and are classified packaged, <br /> marked and Iabeledtplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regula8ofrs_ export shipment and I am the Primary <br /> Exporter,I certify that the oontsirtls of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> cefiFj 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 he, - <br /> ±�&.q <br /> erors Pdnled(Typed Name Signature - Month Day Year <br /> 0 3 1 s z6 <br /> j 16.International Shipments <br /> i- ❑Import to U.S. ❑Export from u-8. Pod of entrylexit: <br /> ? Transporter signature(for exports only}: Date leaving U.S.: <br /> lK 17.TransporlerAcknowledgment of Receipt of Materials <br /> r 1 Pdntedlfy a nalure Month Day Year <br /> a <br /> Zrter2Pdnted Name <br /> d Month Day Year <br /> AIA, <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 181b.Altsmate Facility for Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ti FaciliVs Phone: <br /> W t8c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> d <br /> Z <br /> h19.Hazardous Waste Q#port Manilgement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Lu 1. 2. 3. 4. <br /> ff Iq <br /> 26.Designated Faci dy Owner or opera r:CaNcation of re pt h materials covered by the manifest except as noted in Ite <br /> Printed/Typed Name �igmaWre t cur <br /> AA kl 11A <br /> EPA Form 8700-22(Rev.12-117)P editions are o r^(� DESIGNATED FACILITY TO EPA's e•MA IFEST SYSTEM <br /> 1)B005834!1506936 2)7612003!156777 <br />