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SSL SK SHIP# 230267992 IIINIIIIIUINII�N�IIiIIIN <br /> SKS <br /> Please print or type. D Forrm Approved OMB No.050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.P e 3.Emer en Res rise Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000083287 1—�0�-4�8-1760 007276011 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Swift Transportation Co <br /> 901 Darcy Pkwy <br /> LATHROP CA 95330-8764 <br /> Generators Phone: 209-858-7027 <br /> s.Tran SRFET'Y- EEAi SYSTEMS INC u.s.EPAloNumber TXROOOO61205 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> S.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> Faulitys Phone: SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <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 Ouanfity Wt.NoI. 13.Waste Codes <br /> r NON RCRA HAZARDOUa WASTE SOLIDS, DN P 512 <br /> o EMPTY DRUMS);^1dY �AQ1 <br /> LU <br /> 2 NOILRFRLTERS�RDOUS WASTE, SOLID DM P 223 <br /> 3 450 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:SJ 81749040 _5W10083 CSG., <br /> 24H EMERGEIY#800-468-1760—CH/SK/TFI—Contract reta ea 6y generator confers a?: <br /> enc, au ori y <br /> g=tprs on 15. GENERATORWOFFERQR RTIFICATION:I hereby declare that the contents of this consignment are fully and accurat described above by the proper shipping name,and are classified,packaged, <br /> marked and labeletllpla an0 are in all respells 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 114 'ef his consignment conform to the terms of the attached EPAAcknowledgmentof Consent, <br /> I certify that the waste mmlrmzehort statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a smal quantity generator)is We. <br /> Gffe�"n1QdlTyped yarns � Signature Month Day Year <br /> {�� /��Jti �A f7,0 <br /> -j 16.€ntemational Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(far exports only): Date leaving LLS <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> K <br /> TVinnipsor 1 PrintedlTyped Namee�] f nature Month Day <br /> Year <br /> d f JI ` / I / <br /> z Trans er 2 P nt�`rltyp Name Signature , Month Day Year <br /> 't n , /a <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type <br /> ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Atemate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL Facility's Phone: <br /> W 180.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> V 19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> N <br /> Lu 1. 2. / 3. 4. <br /> 20.Designated Facili Owner of Operator.Certification of receipt of us materials covered by the manifest ex as noted in Its <br /> Prime((Typed Nam Signatu Month Day Year <br /> EPA Form 8700-22Rev.12-17)Previous editions obsolete. DES ATEA LITYT EPA's ti-MANIFESTSYSTEM <br /> 1)764735 /1041882 2)7612003/15 77 <br /> l <br />