Laserfiche WebLink
b, SHIP# 222182260 <br /> Pftprt or type,(Form designed for use on elite(12-pitch)Iypewriter.) Form Approved.OMB No.20511-0039 <br /> Page 1 of 3.Emergem Response Ph" Manifest TrwWrQ Number <br /> 'WASTE MANIFEST -T rQ05979794 SKS <br /> Uffir-1RNI1kWD0US [!��I:DNumbff CAL0003987 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(it different than mailing address) <br /> Paradise' Poiret Marina <br /> 8095 Ric Blanco Rd <br /> STOCKTON CA 95219-8703 <br /> Generators Phone: 000 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY-KLEEN SYSTE14S INC TX000081205 <br /> 7.Transporter 2 Compirry Name U.S.EPA 10 Number <br /> 'CLEAN "BORL E250 <br /> 8-Designated Facility Name and 8-deAddressU.S.EPA ID Number <br /> CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD <br /> CA 95133 <br /> Fadlity's Phone: 4IDS-441-0%2 SAN JOSE C(.10059494310 <br /> go, Str.U.S.DOT Description(inducting Proper Shipping Nah*,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) Nb. Type Quantity Wt-Nol. <br /> rr X 1 UNN1266, WASTE3PETROLEUM DISTILLUES, DM P W011 D606 D018 <br /> 0 .O.S. , , PGO TI <br /> +MWI NUN RCRA HAZARDOIS WASTE SM-IDS, DM P 352 <br /> (OIL, DIRT AND SAND), NA4- J <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:SJ 73477421 PA23059 C&G: <br /> I)ERG#128- t <br /> 24 HR Eta 46ENCY 418ft-465-i760 (SK TFI) - <br /> L I rb n rAIELC RY <br /> QILTW Q-q fiftTko" ay 14!�E�etsd`ftl`F " lly;w��� <br /> 15. GENEMT0R$WFL:*0"1V$MTL9CAT0N: [hereby dedana ihtsioppioirfi4maritully bed above by the proper shipping name,and are dassified,packaged, <br /> marked and labeled/placapled,and are in all resp"in proper condition for transport according to appkable international andinationai governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to theterms of the attached EPA&k rwwledgrr e, ntofConsent <br /> I ce0y#wt4havaste mjmuabmstateitMxttideE�sfied.040.CFRIB227(a)(if 1aMaIaW.qw*qenarator)or(b)(41 am small quantity generator)is true- <br /> 7 810fterqrs Printed/Typed Name Signature Month D Year <br /> 1 <br /> -116.1 International Shipments <br /> 1-- 0 Import to U.S. ❑Expert from U-S. Port of entryle)dt: <br /> T= Transporter signature(for experts only): Date leaving U.S.. <br /> t0l� 17.Transporter kknowtodgTent of Receipt of Materials�u <br /> T7r 1 Plrinted[T)900 Nam Signature Month Day Year <br /> tA <br /> CL <br /> 'n <br /> Z Tlarlsspo�i6 yped Name Signature Month Day Year <br /> 4 <br /> 18,D-4myry <br /> 18a.Discrepancy Indication Spam 0 Quantity ❑Type t J Residue ❑Partial Rejection ❑Full Rejed. <br /> -7186.—AlternateFaai�ty-(or-Generator)—. U.S.EPA ID Number <br /> FacilVs Phone <br /> u, 18c.Signature of Aftmate Facility(or Generator) <br /> Month Day Year <br /> 19,Hazardous Waste Report Management Method Codes(.e.,oodes be hazardous waste treatment diW-1,and recycling systems) <br /> LU 1 <br /> Z <br /> t. 4, <br /> 20.Designated Facility Owner or Operas or:Certification of reoeo of hazardous materials covered by the manifest except as noted initern 18a <br /> Punted typed Name Sgiature <br /> T-7 "th Day Year <br /> . _7, <br /> EPA Form 8TOO-22(Rev.305) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />