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SSL .. SK SHIP# 226521042 Please print or type. Form Approved.DMB No.2050.0039 UNIFORM HAZARDOUS 1.GaneratorlD Number 2,Page 1 of 3, Te-1999- e R s se P 4.Manifest Tracking Number CRl.�1O0Q115Ef3f) 1. �-�.��'�i'-�,��--1�'�01006961349 l WASTE MANIFEST SKS 5.Generators Name and Mailing Address Ganerators Site Address.(if different than mailing address) Tian Juar�uirl Ca Maintenance 181 4 E F#azelton Ave STOCKTON CA 952O3-6232 h - Generators Phone: ' 6.Tr? rtar ompArly t SYSTEMS INC U.S.EPA ID Number TXROOOOBIP-05 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address CLEAN HARBORS SAN ;l'fl',aE U.S.EPA ID Number 1021 BERRYESSA ROAD SAN JOSE , CA 95133 +08-44-1--10962 C;{�I:iQi'59494310 Facility's Phone: ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Packing Group(if any)) No. Type Quantity WI,NoI. 1. NCIH-RCRA HAZARDOUS WASTE, SOLID � DM r � ) P 223 o SOIL FILTERS) U3 U3 Z 2. LU C7 3. 4. 14.Special Handling Instructions and Addilionai Information TSO i SJ 801 1413,.1 SAV2680 CSG I: 24H EMERGENCY#800- 468-i76O--CH/SK/"IFI-Contract retained by generator confers additional agency authnri 'y on initial. trans arter�� to add or Substitute s t u t ns q I trans artersr on c enerattfr s behalf. 15. GENERATOR'SIOFFEROR'S 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, marked and labeledlplacarded,and are in all respects in proper condition far transport according to applicable international and national governmental regulations,If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. I certify that the waste minimization statement identified in 40 GFR 262,27(a)(if(am a large quantity generator)or(b)(if I am a small quantity generator)is true. Genefalorsf0lferors PdntedlTyped Name Signature Month Day Yeat 16.International Shipments H ❑import to U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials LLI K Transporter 1 PdnledfTyped Name Signature Month Day Year Transporter 2 Prin4edffyped Name Signature ,� Month Day Year is 18.Discrepancy 18a.Discrepancy Indicatlon Space ❑ a... ❑Residue ty ❑Type ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V LL Facikty's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q � CD Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. J. 4. 20.Designated Facility Owner or Operator:Certification of recelpt of hazardous materials covered by the manifest except as noted in Item 18a Prinledffyped Name Signature - Month Day Year EPA Form 8700.22(Rev.12-17 Previous editions are obsolete. GENERATOR'S INITIAL COPY ` K_, 1)7612003/136777)