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SSL SK SHIP# 2 c781171 .'-1 111111111111111111111111111 11111111111 0064590558 K8 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1'Generator ID Number 2.Page of 3. .me R s e P 4.Manifest Tracking Number WASTE MANIFEST L:At_>n 0,35&_31 NWI FIr. �1 0 6953055 SKS 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) 12 8 D Lift Inc. 3820 Rhonda WEy TRACY CA 95:304-1613 Generator's Phone: 209-229-7440 6.Trans der 1 Com any Name U.S.EPA ID Number 6 - ETY41LEEN SYSTEMS INC T ROfhOOS1205 7.Transponer 2 Company Name U S.EPA ID Number _ CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 8.Designated Facility Name and Site Address CLEAT`-] HARBORS SAN JOSE U,S,EPA ID Number 1.021 BERRYESSA ROAD SAN JOSE , -CA 95133 Facility's Phone 9a. 96.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes RM and Packing Group(if any)) No. Type Quantify WLNoI. NON RCRA HAZARDOUS WASTE SOLIDS DM P 2.23 o (DEBRIS, PETROLEUM HYDROCARBONS) 3 w z. NON-RCRA HAZARDOUS WASTE, SOLID DM P L,"3 (OIL FILTERS) 3- 4. 14.Special Handling Instructions andAddilionai Information TSD e SJ 79296 721 DD02783 �CSG � 24H EMERSENCY#00--468-1761 -CH15K /TFJ-CT tract retained by gen rat�or co>�f@r~s ager y authori y on initial t r t d t tute additional transport r n ener2lor's behalf, 15. GENERATOR'S/OFFEROR'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, marked and labeledlplarardedand 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(III am small quantity generator)Is(roe. Herons PdntedlTyp d Name Sign u Month Day Year 16.International hipments f— ❑Import to U.S. ❑Export from U.S. Pod of entrylexit: ? Transporter signature(for exports only). Date leaving U.S.: W 17,Transporter-Acknowledgment of Receipt of Materials IrF18a. o 1 PrintedlTYped a nature Month Day Year CLI ` -Al 115 z 'ter2 PrintedT arae ure Month Day Year 9 crepancy screpancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: r 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: - w %c.Signature of Alternate Facility(or Generator) Month Day Year z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 13 , /1/I 2 #/-/// 3 ::T . 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as d in Item 18a Pdntedll' me Signalure Month Day Year 3 12111 EPA Form 8710-22(Rev.12-17)Previous editions are obsolete. I.?i?3t1?X3334 Y51b65<,t� .)7F.1;=_4� 5:!1�6??7 DESIGNATED FACILI 0 EPA's e-MANIFEST SYSTEM