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F=GA 1®® oej <br /> SSL SK SHIP# 220867125 11111111111111111111111111 IN III I III <br /> 0057266528 K8 <br /> Please print or type. (Form designed for use on elite (1241tch) typewriter.) Form Approved , OMB No. 20500039 <br /> UNIFORM HAZARDOUS 1 , Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number r� SKS' WASTE MANIFEST CAL000299414 1 1 800-468 - 1760 0 0 5 7 2 8 6 5 2 SKS <br /> 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> Chris CO <br /> 1001 Stokes Ave <br /> STOCKTON r CA 55215-4023 <br /> Generator's Phone: 209--pp948-3038 <br /> 6. Transrter 1 Com any Name U .S. EPA ID Number <br /> SAFETY—tmLEEN SYSTEMS, INC. TXR@00081205 <br /> MINIM 0 <br /> 7. Transportea Company Name U.S. EPA ID Number 50 <br /> 8. Designated Facility Name andSite Address CLEAN HARBORS SAN JOSE U,S. EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408- 441 --0462 i CAD@59494310 <br /> Facility's Phone: <br /> I ga. 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 (I any)) No. Type Quantity WtJVol. <br /> ! cc X ' UN19931 WASTE FLAMMABLE LrGUIDS , � DM (ARP D001 D018 213 <br /> ' c0 . 0 £ S . , ( GASOLINE, ANTI —FREEZE ) , 31 P <br /> LU 2. <br /> ` D7 <br /> 3. <br /> 4. <br /> 14. Special Handling Instructions and Additional Information TSD': SJ 71865332 CH40434 CSCE <br /> 1 ) ERG# 128 • ( 2W <br /> 24 HR EMERGENCY # 1 -800-468- 1760 ( SKI TFI ) <br /> rr <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION : I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeledlplacarded, 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 EPAAcknowledgment of Consent <br /> I certify that the wa to minimization statement identified in 40 CFR 262.27(a) (if 1 am a targe quantity generator) or (b) (i(I a small quantity generator) is we. <br /> General Otieror's ri ed/Typed NameSignature Month Day Y <br /> Zoe <br /> —;t 16. In ernational hi n <br /> F. Import to U.S. ❑ Export from U,S, ort of xit: <br /> �= Transporter signature ( 1ports on y): e I .S, : <br /> 17. TransporterAcknowiedgment of Receipt of Materials <br /> T 1 Printed ed Nam, A Sign n �e <br /> G V v ` <br /> Tra ' r 2 P nie yped Name Si nature Month Day Year <br /> _ G o <br /> 18. Discrepancy <br /> 18e. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> awl <br /> �i <br /> u: Facilitys Phone: <br /> C1 wwwww <br /> IBe, Signature of Alternate Facility (or Generator) Month Day Year <br /> Far <br /> 2L <br /> 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 01 . Vi-4 <br /> 2. 3. <br /> ! 20, Designated Facility Owner or Operator: Cedification of receipt f h rdous materials covered by the manifest re as noted In I m 18a M nt� ea <br /> Signature <br /> Print Name <br /> C <br /> DESIGNATED pACJLIY'YZr'O DESTiN t TATE {SF R� Q+tBtf�'ri �", <br /> obsolete. <br /> EPA Form 8700-22 (Rev. 3 05) Prev(ous edI tons are <br /> 1. 177r'�2.619 / 1196328 - <br />