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',�;_ &V Si4IP# reap <br /> Please print or type. &,S�Pq7?5 Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.P%ge o 3. me Res o se Ph 4.Manifest Tracking Number <br /> CAE_00t 035@831 -� = 4�a�- y' a <br /> 1006960297WASTE MANIFEST SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> D & D Lift Inc. <br /> 3823 Rhonda Way <br /> TRACY CA 95304-16@8 <br /> Generator's Phone: � �_ 4e'-744id <br /> s.Tr �1.Co r n� SYSTEMS INC U.S.EPA ID Number TK ROOOO81205 <br /> 7.Transporteri2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> s. <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 102:1 BERRYESSA ROAD <br /> 5AN JOSE , CA 95133 <br /> 408-441-09G2 SAN <br /> Facility's Phone: <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)) No. Type Quantity Wt.Nol. <br /> 1. NON RCRA HAZARDOUS WASTE SOLIDS P 223 <br /> (DEBRIS, PETROLEUM HYDROCARBONSI <br /> !R a _.. Li <br /> k:...; <br /> Z 2. NUN° f`RA HAZARDUU§__WAS.TCFY _SOLID � DM 223 <br /> (OIL FILTERS) \ <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information 'l-'D.S C 802921620 DD&-783 (;S(j <br /> 24H E-ME ENCY#800-4Er9-1760-CHISK/TFI--Contract retain6d y generator co"n"ifers a enq� qaauthqority <br /> on nit ' transporter Substitute ,.- <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 labeled/placarded,and 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 <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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 truer <br /> [��Off ror's PrintedlTyped Name Signature Month �Day Year <br /> J 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> T er 1 Printed/Typed Na gnature onth Day Year <br /> Olt <br /> CL <br /> u� Mon Day Year <br /> iter 2 Pyaied/Typed Name f <br /> ^-' <br /> 1 iscrepancy <br /> T8-a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejectk., ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator* U.S.EPA ID Number <br /> J <br /> U ` <br /> rai Facility's Phone: Y' <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 2 f 3,.. 4. <br /> 20.Designated Facility Pwner or Operator:Certification of receipt olhlawrdous materials covered by the manifest except Ooted in Item 18 / <br /> Printed/Ty ed Name nature / � ! f/, Month Day Year <br /> EPA Form 8i700-22((Rev.12-11Previous editions are solete. / D I NATED " CILITY TO GENERATOR <br /> 1)Fi005t-V 1506536 2)7;A1-2__ 155 7 f <br />