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fill <br /> SSL SK SHIPS a 0 6 5 13915 5 K 3 <br /> Please print or type.(Form designed for use on a Its 12-pitbf yyo r tel Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS Generator kD Number 2.Page 1 of 3.Ene gen Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000346Sfs1 1 1-8a -458-1760 513 SKS <br /> 5.Generator's Name and Mailing Address Generatofs Site Address(if different than mailing address) <br /> TCI Leasing & Rentals <br /> 2150 W Charter Way <br /> STOCKTON CA 952106-1118 <br /> Generators Phone: 209-941-4034 <br /> 6.Trans der 1 Com any Name U.S.EPA ID Number <br /> SFETY-(LEEN SYSTEMS INC TXR0010081205 <br /> 7,Transporter2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC- <br /> 8, <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 /> 408-441-0%2 CAD059494310 <br /> facilitys Phone: ' <br /> ga 9b.U.S.DOT Descriptwn(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WLNol. <br /> 1 <br /> QK <br /> uj X 2. NA1993, DIESEL FUEL, COMBUSTIBLE / DF god P 223 <br /> LIQUID, PG III <br /> 3. NON RCRA HAZARDOUS WASTE SOLIDS, ' DM P 512 <br /> (EMPTY DRUMS), <br /> NON RCRA HAZARDOUS WASTE SOLIDS, DF P 512 <br /> (EMPhy DRUMS), <br /> 14.Special Handling Instructions and Additional Information SD-SJ 76552866 TC10591 �} CSG: <br /> 24 HR EIMEASENCCYY #i81 --468-1760 (CH / SK / TFI) JW <br /> I / <br /> n _ Y <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and aau described above by the proper shipping name,aid are ed.packaged, <br /> marked and labelecilplacarded,and are in all respects in proper condition for transport according to applicable intemahonal and na at 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 certyy 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 true. <br /> Generator`Offerors PrintedlTyped Name Signature Mon Day Yearuli /4a <br /> IY- <br /> -J 16.International Shipments <br /> H ❑importto U.S. - - ❑Export from U.S. Port of entrylexiL• <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> LX 17.Transporter Acknowledgment of Receipt of Materials <br /> ~y. Transporter 1 PnntedRyped Name _ Si re Month Day Year <br /> a <br /> U) Transport r2PdntedrFyped Signature Month Day Year <br /> ��sr to <br /> 18.Discrepancy <br /> Ise.Discrepancy Indication Space ❑puantity ❑Type ❑Residue ❑Partial Rejection ❑Fu:Reoclio i <br /> Manifest Reference Number. <br /> 18b.Atemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Atemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardouswaste treatment,disposal,and recycling systems) <br /> O t 2. 3. / 4 <br /> 20.Designated Facilityer or Operator:CerlifiSadon of ref hazardous materials ered by the manifest except d in <br /> Pnntedffy Na a Signahrre Month Day Year <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsolete DESIGNATED FA ITYTO STINATION STATE(IF REQUIRED) <br /> 2)8257793 630063 3)8256190/1630141 4)82 1 <br /> 90/1 30141 <br />