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SSL SK SHIRE � v�� <br /> �� Zy' 0057394sKs <br /> Please print or type.(Form designed for use or elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000346561 1 1-800-468-1760 I0 0 6 513 9 2 3 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> TCI Leasing & Rentals <br /> 2150 W Charter Way <br /> STOCKTON CA 95206-1118 <br /> Generator's Phone: 209-941-4034 <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 /> C&n Z7D <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS. OF WILMINGTON LLC U.S.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON , CA 90744 <br /> Facility's Phone: 310-835-9998 CAD044429835 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 0 1 NON-RCRA HAZARDOUS WASTE, SOLID DM QOO P 223 <br /> (OIL FILTERS) <br /> z 2. <br /> L <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> TSD.WI TC10591 CSG-. <br /> 24 <br /> 24 HR EMERGENCY #1-800-468-1760 (CHI SKI TFI) �e V X4 <br /> 15. RAT 'SIOF ROR'S CER IFICATION: I here y declare that the contents o this consignment are fu ly an accurate y described a ove by a 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 true. <br /> Generators/Offerors Printed/Typed Name Signature Month Day Year <br /> 16.International Shipments <br /> z1:1Import to U.S. ElExport from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Trans iter 1 Printed/Typed Name Signat Month Day Year <br /> CL <br /> C� A&I&X f�`1 l <br /> ZQ Transporter 2 Printed/T Name Signature Moth Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type y ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> >- 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> _J <br /> V <br /> � Facility's Phone: <br /> LO 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> c <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Fn <br /> 0 1. 2. 3. 4. <br /> -) t" <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> ) n P,:j V-�,,- 1 8-1�� 1 '-A I '173111 <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1)7612003/156777 <br />