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III II I I II I I II IIIINI I NI II INi II i iIII <br /> SSL SK SHIP# 225310438 0 0 6 5 2 0 5 6 5 S K 5 <br /> Form Approved.OMB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) (� C C <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4�Manjfest <br /> Sn NOh�v� V�vWASTE MANIFEST CALO00346561 1 1-800-468-1760 <br /> 5.Generators Name and Mailing Address Generatats Site Address(if different than mailing address) <br /> TCI Leasing & Rentals <br /> 2150 W Charter Way CA 95206-1118 <br /> STOCKTON <br /> _ Genereto1s Ph one: — U.S.EPA ID Number <br /> 6.Transporter 1 Company Name T TXROOOO812O5 <br /> SAFETY—KLEEN SYSTEMS INC <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name MAD$3932225O <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. U.S.EPAID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD GR 95133 <br /> SAN JOSE + CADO59494310 <br /> Far 2'a Phone: 408-441-0%2 ' <br /> 9a. <br /> 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quanfity Wt.Nok. <br /> HM and Packing Group(if ani <br /> tr X s. NA1993, DIESEL FUEL, COMBUSTIBLE i DM P 223 <br /> 0 LIQUID, PG III 1 <br /> LU 2. <br /> LU <br /> t� <br /> 3. <br /> 4, <br /> 747Special Handling Instructions and Additional Informal ,TSD.SJ 76718932 TC 10591 /� �,(C�SG�: <br /> 1)ERG#128• I b 0 ��Vtf�O <br /> 24 HR EMERGENCY #1�r8OO-468-1760 (CH ! SK ! TFI} <br /> u <br /> 15 '510 C R CATI here y d are the a con en o is consignmen are y an accurate y n e a ove y ropers ipping name,arcl are classified,packaged, <br /> marked an abeledlplacarded,an arein all pects proper condition for transport according to applicable international and national goverment Mations.If export shipment and I am the Primary <br /> Exporter,I rtify that the contents-f this voEi nme conform to the terms of the attached EPAAcknowledgment of Consent. <br /> rA the waste minimizaG9 statem t e n CFR 262.27(a)(if l am a large quantity generator)or(b 'iI am a small quanN rotor)is true. Month Day Year <br /> Signa <br /> Generate roe Pri a16.Intemati ments Ira ❑Export from U.S. Port of trylexit: <br /> r Date leaving U.S.: <br /> Z TransporteYsr ature(fore ods I <br /> w 17.Trenspo r knowiedgment of lot of at pals Month Day Year <br /> Signature <br /> K Tra Po r 1 ntedlT ad Naii O <br /> b <br /> 0. Month Day Year <br /> Signature <br /> X Transporter 2 No edR arae —� Z� <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantl <br /> Type <br /> ❑Residue ❑Pallial Rejection ❑Full Rejection <br /> ty <br /> man:-"Reference Number: <br /> U.S.EPA1D Number <br /> 18b,Alternate Facility(or Generator) <br /> J <br /> U <br /> LL Facility's Phone: Month Day Year <br /> W loc.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> c 1 � 2. <br /> 20.Designated Facility Operator:Certifi tion of re of hazardous materials covered by the manifest a pt noted In Item 16a M <br /> Signatu <br /> PrintedfTyped Name <br /> EPA Famt 6700-22(Rev.3 <br /> VI sediUo areob e. D IGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1)B257793l1630063 <br />