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SSL SK SHIP# 225273323 il�llllllllfl�illfli�llllllNIIIIIIII <br /> 0 0 6 5 2 0 5 1 7 S K S <br /> Please print or type.(Form designed for use on elite(12-piich)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracktnber <br /> WASTE MANIFEST CAL000100247 l i—$ �-46F�-1760-10065H517 S K S <br /> Generator's Name and Mailing Address Generalor's SilaAddress(if different than mailing address) <br /> American Honda Motor Co. <br /> 123 Val Dervin Pkwy <br /> STOCKTON CA 95206-4001 <br /> Generator's Phone: 209-982--5090 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY—KLEEN SYSTEMS INC TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA!D Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 9513; <br /> Facility's Phone: 408-441-0962CAD059494.310 <br /> 9a 9b.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 /> X 1. NA3082, HAZARDOUS WASTE, LIQUID DM P D008 D018 223 <br /> N.O.S. , (LEAD, BENZENE), 9, PG III , <br /> w <br /> L2, , ur•r f1 <br /> cI ( . f.A <br /> 3. <br /> -D I h C 01& 4,4Wr,,4,r AST NO 15 P <br /> 4. <br /> Spatial Handling Instructions and Add!tionel ln{orrnation TSD:SJ 76672035 AM23152 CSG: e2 <br /> 1)ERG#171• �pp�00\10 <br /> 24 HR EMEhGENCY #1-800-468-1760 (CH f SK / TFI) �' <br /> rr _ " <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare That the contents of this cdnsignmertt are flay and accuralety described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlp!acarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and!am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(f I am a small quantity generator)is true. <br /> Month Day Year <br /> rnetafes/Offaroes Printedlfyped Name Signature <br /> J 16. emationat Shlpman <br /> z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> Ll 17.Transporter Acknowledgment of Receipt of Materials <br /> Tra rler 1 Printed/TRdErName Signature ' Month Day Year <br /> Q Transpo r 2 P ntedl7 ame Signature Month Day <br /> Year <br /> <-T wng <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ quality ®Type j ❑Resldu ❑P�Iiiel Reaction El <br /> r� 1�u Full Rejection <br /> r41 J RQ Ov�� Dir rn 1=vDYn C.i1� I �uc�c A v�p T c��n pleaje s&e - <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 180.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> S2 '^ Hazardous Waste Rt Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> rr Report <br /> C- / ell 2. 3. '1zll 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as note Item 18a <br /> PrinledlTyped ^ Signature <br /> Month� <br /> LIQ l_ <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ❑ S)GNATED FACILITY TO DESTIN TATE(IF REQUIRED) <br /> 1)7165920/40566284 <br />