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SSL SK SHIP# 231840159 <br /> 007440311111 <br /> Please print or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2. 7l, <br /> melgg��v R s�tp�e Papp 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000358631 P 1 t3t/f10— btl 1/�0 1007440383 <br /> 0 3 SKS <br /> 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) J �7 f�V , <br /> D 8 D Lift Inc. <br /> 3820 Rhonda Way <br /> TRACY CA 95304--1608 <br /> Generands Phone: 209-229-7440 <br /> s.TngppLU.S.EPA ID Number <br /> SYSTEMS INC TX 8000081205 <br /> 1pp�yNe <br /> 7.TmnsRporter 2 Company Name U.S.EPA ID Number <br /> GLEAN HARBORS ENV SVC INC. MAD039322250 <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 <br /> CAD059494310 <br /> 408-441-0962 <br /> Faclllt�s Phone: <br /> ge Do.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, I ype I Quantity Wt.Nol. <br /> NON—RCRA HAZARDOUS WASTE SOLID 11 DM $� P 223 <br /> o (DRAINED AND UNDRAINED OIL FILTERS) <br /> as USED OIL FILTERS CONTAINING USED OIL <br /> z 2. <br /> Lu <br /> 3. <br /> 4. <br /> IC Special Handling Instructions and Additional Information TSD.-SJ 83661931 DD02783 CI <br /> o90WV4)-7 do <br /> 24H EMERGENCY#800-468-1760—CH K/TFI—Contract retained 6y gene a or confers agency authorf y <br /> ',,nn initial tCansp tt.15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment awfully 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 certfy that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> cedify that the waste minimization statement identified in 40 CFR 262.27(a)(ti I am a large quantity generator)or(b)(if I am a small quantity generator)is true, <br /> Generatorsl0fferor's PdntedRyped Name Signature <br /> Month Day Year <br /> T <br /> �04r1 0 1( <br /> _j I 16.ntemational Shipments <br /> i— ❑Import to U.S. Export from U.S. Port of enbylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> K ITTransporerAcknowledgmentof Receiptof Materials <br /> Liu <br /> KPrint ype <br /> Tmnsporte d Name Signature Month Day Year <br /> CL <br /> 2 ?� <br /> Z Tran r 2 Pnnted/Typed Name SignaW Month Day Year <br /> Jct` 1. <br /> 18.Discrepancy <br /> 1 Ba.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j <br /> ❑Partial Rejection Full Reedion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> IFacility's Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. <br /> 20.Designated Facility Owner or Operator Certification of receipt of h rdous materials cover y the manifest except ndetl in Ite <br /> Printedliyped Name SignaWre Month Day <br /> Day Year <br /> ((� 71 pp / <br /> EP F <br /> 1)7612003/156777 evious editions are obsolete. DE S1G ED FACT Y TO EPA's e-MANIFEST SYSTEM <br />