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SSL SK SHIPi# aP7425454 II IIIInIII II �I I�II�I�IIIIIIII ' <br /> cob77sSb + 9 sacs <br /> Please plfntor typo, Form Approved.OMB No.2g51}Dt)3g <br /> UNIFORMNAZARDOUS 1.Cenerafiwo umber rAl-0010406.30147 12.Pagel of 3.� $glv�Bv¢ � 4.Man stTNcNingNum ar q <br /> WASTE MANIFEST DD6776611 ,SKS <br /> S.GaasrelpPS NamaBnd NlatllrgAddrgss5t Inc Ranamlora SiYDAddhlna liFdElEBreM Nan meilrFa add'er3) <br /> Rt7lY B9E?1 i11rHC'L' W <br /> 3861 Durst Creels Dr PD Box 31086 <br /> STOCKTON CA 95215•-7556 <br /> Generator'aPhpna: S1�°"'857-10rb� <br /> B.Trr�1g.�Cq-m�rCftR9 SYSTEMS INC U.S.EPA 3DNembot T `t 00 1 1b"J <br /> T. MINA H��F�9M ENVIRONMENTAL SVC .TN(:. U.S.EPAIDh'Um6ar MAD10393 2250 <br /> 0.Dealgaeled Pealily Name and SIIeAddmsa C LEAN HARBORS SAN JDSC U.S.ER4ID Number <br /> 1021 BERRYESSA ROAD <br /> BAN JOSE' , CA 9?133 <br /> 408-441-0962C#iBpS54DAo 1 QI <br /> Fadarye Phone: . <br /> 9a. %.U.S.DOT Daspdpaco lercluding Pmperftli lg Narrre,Hasad Class,ID Number, 10,CanlaMgrg <br /> 1111.tow 12.Un11 i3lwa91e�s <br /> wandPadalgGroup(if any)) No. rypa QuanAly <br /> 1• NDN AND ABSORBENTHAZARDOUSS)WASTE DLIAS, 4U5ED � I1M #7 3:i2 <br /> o QIL AND AB5DR8EldT51 <br /> 2• N -,R RA HAZARDOUS lJFiSTE, SOLID QM p8 <br /> m (OIL FILTERS) <br /> 3. <br /> 4. <br /> 14. pedal Handling ln*acaone and Addlllanal lnfoanagorl ,I 78954841 DI RI'516 �y ��+�y,,CS <br /> (� TN -` <br /> 24H EMER{-jENCY#i800-•468-1760-CH/SK/TFI-Contract retained by venerator confers a envy authors y <br /> an initial trans orter to add or substitute additional trans Otters angenerator's behalf. <br /> 15. GENERATOR'SfDFFEROR'SCERnFICATtON:lhereby declare Mai Ihoconwls(11NlsconsrgnmentamI*and wmi lydoscrtwabovebylhepropershippigneme,aalareclassilled.padaged. <br /> marked and knbeladlplacnrded,and are In all reapacts in prapermnddion forwanspan according in applicable ielemabonaland nalkusel governamtal regul;sions.It wWd shipment and I am as Mal <br /> Exp iW I muly Nal Ne co"tomis of Ibis conslgiment Carbon 10 the leans of Ile a0acirad EPAAcknowl !imnt of Consent <br /> !caul Ihat Ne waste mlramlrationalalement ll In 40 CPR 262.27{a)ff I am a quarnktanem�r a smo gaanHtyge fpr)li lua. <br /> General Pr WTt ped Name AWMonthare <br /> Day Your <br /> A� <br /> 1 Intemaknal5'pmentaI-'-r �^I <br /> ❑lmporttoU.S. 1...,pExport PortafatrylexiC <br /> K TraasPORprrgmdurn(0axp rtsonly): lalrzrringU.S.: <br /> 17.TranuodarAcknawletrrenl of Recall of Materials <br /> 6 Tmn 1 yl 8igrm[ure Mo* Day Year <br /> P' <br /> yPau Name Sign .Math <br /> 18.Discrepancy ' <br /> 18a.DiscreirlIndlcelfonSpnon ❑ou"ly ❑T'l ❑Resklue 1:1PadWR4)sdkir5 rJFWRajesOal <br /> ManilostRefar Number•. <br /> t� 184.Allonam l(na Oanoralsr) U.S.EPA ID Number <br /> Lar. Farr7fly'S Prang: <br /> tan.Signalers pfAltarnalp FACaily{ar Gerreralor) MsrSN Day r <br /> 4 <br /> Z <br /> 19.HazatmrsWasiaReport ManaomralMalhodCadesp.e,co4ascrhazardeaswaslalrealmoal,dist 1,and rec"Ing",oma) <br /> O 1. 2. ] S. 4. <br /> 20.Designated FarAlly perMor;CwUrica nal hazardous maledals caverad by the menifeslezcepl m nd I <br /> Pridedrlypeo Name 'meets <br /> EPQF} a r� RtavlD �d o 6777 IDESIGNATEO FACILITYTO EPNs a-MA IFEST SVISTffA <br />