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SSL SK SHIP#!�` � ��' <br /> Please pentortype. 006636736SK3 <br /> UNIFORM HAZARDOUS I.Generator ID Number Form Approved.OMB No,2050-0039 <br /> CALM0433477 2.Aage 1 of 3. m_ _R a Pty 4.Manifest Tracking Number <br /> WASTE MANIFEST 1 3 �+ 1/b0 ^��� � ��� <br /> � <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing a0066867 <br /> O�bddress)Treedco uck Lube #338 <br /> 3 At Jackstone Exit — <br /> RIPON <br /> GeneratoYs Phone: <br /> 209-599--7961 CA 95366-0000 <br /> 6.Trir > SYSTEMS INC U.S.EPA ID Number <br /> TXR000081205 <br /> 7.Transporter 2cHayBNDCCtS ENVIRONMENTAL SVC INC, <br /> K U.S.EPA ID Number <br /> B.Designated Facility Name and SileAddmss CMAD0393222501-E(� HARB€3RS SAN J05E U.S.EPA ID Numb <br /> 1021 BERRYESSA ROAerD <br /> 408-441-0%2 SAN JOSE , CA 95133 <br /> Facility's Phone CAD059494310 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, <br /> HM and Packing Group(if any)) 10.Containers 11.Total 12.Unit <br /> 1 No. Type Quantity WtJVol. 13,Waste Codes <br /> K <br /> O <br /> a <br /> L <br /> W <br /> Z z NON_ RA HRZARDGUS WASTE, SOLID P <br /> (OIL FILTERS) DM 223` <br /> 3. hU <br /> 4. <br /> 14.Special Handling Insbuctlons and Additional Information TSD:SJ <br /> 78090511 SP22107 CSG: <br /> 24H Eh RGENCY#800-468-1760—CH/SK/TFI—Contract retained I /— �� gg <br /> on initial transporter to add ar substitute additi©nal transnorters on fensratarnc hehelfl y <br /> 15. GENERATOR'510FFEROR'SCERTIFICATION:I hereby declare that the contents of this consignment are fully and an <br /> described above by the propershipping name,ab are classified,packaged <br /> marked and IabeledlplaraMed,and are in all respects in proper condition for transport according to appiicable 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 waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator'sl0themes <br /> Pdnted(Typ Name Signature <br /> V C� Month Day Year <br /> 16.Intern ti nal5 en <br /> i171Importto U.S. ❑Export from U.S. Pon of entry/exit• <br /> Transporter signature(for exports only) <br /> W 17.TranspoderAcknowledgmenl of Receipt of Materials Date leaving U.S.: <br /> Tran oder 1 PrimedfTyped me <br /> 0O l�,, 1 Signa <br /> to 1 (;.u.t(H ± Month Day Year <br /> a Tra 2 Pnnted/Typed Name ,(� as t <br /> a� gnature �!/J7�� <br /> Month Day Year <br /> 16.Discrepancy <br /> 38a.Discrepancy Indication Space <br /> ❑Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> IZ 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> U <br /> U.S.EPA ID Number <br /> LL Facility's Phone, - <br /> L18c.Signature of Alternate Facility(or Generator) <br /> z Month Day Year <br /> W19.Hazardous Waste Report Management Method Codes(I e., odes for hazardou waste treatment,disposal,and recycling systems) <br /> 0 1 2. <br /> e----�_. 3. 4. <br /> 20.Designated Facility 0 er Operator:Cert, tion of re i of hazardous materials covered by the manifest except as note 18a <br /> Pdint edlfype0 Name <br /> Signature <br /> M ay <br /> EPAFgt 87 0-22 Rev. Previous ado Sole <br /> TS 2)761 003/156777 DESIGNATED FACILITY TO EPA's a-M IFEST SYSTEM <br /> r <br />