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S5L SK SHIP#-�2�&I- <br /> ' O O 63 9 7 7 O S K s ` <br /> T x t247 <br /> Form ApQroved.OMS No.2050-0039 <br /> Please print or type.(Form designed for use on elite(t2-pitch)typewfiter.) 1`006Y41730 <br /> .Manifesthaekln Nar}nher <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000433477 2.P 3 fame R s@ 0 0 6 3 417 3 0 SKS <br /> WASTE MANIFEST <br /> 5.G eratoMailingqdd ss Generator's Site Address(O different than mailing address) <br /> rsame a <br /> °ppeef�co ruc cf lube #33$ <br /> SR 99 At Jackstone Exit — <br /> RIPON CA 95366-0000 <br /> 209-599-7961 <br /> Generator's Phone: <br /> 6.Trj3jqfrttS0 RLYP" SYSTEMS INC u.s-EPAIDNumber -T%R@@@@812@5 <br /> 1 <br /> �p�p g�2,Cp�pp�py,�I�q U.S.EPA ID Number KAD039322250 <br /> 7.TrLL�FtIV HF1tSHLiltS ENVIRONMENTAL SVC INC. <br /> 8.Designated Facility Name and Site Address EAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 HERRYESSA ROAD CA 95133 <br /> SAN JOSE + CAD059494310 <br /> 4@$-441-0962 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1g.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity wt.rvol. <br /> T—N—GN—RCRA HAZARDOUS WA E, OLID DIN py\ P 223 <br /> 0 <br /> (OIL FILTERS) ��CCJJ <br /> w 2 <br /> z <br /> Ulu <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:SJ 77728185 SP221 @7 rv,J�'JcoCSG: ^J <br /> o V <br /> 24H EMERGENCY#900-46$-1760—CHlSKITFI—Contract retained by generator nt f 1� <br /> a ency authori y <br /> on initial transporter to add or substitute additional transporters on enerff r°s behalf. <br /> 15. GEN ERATOR'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, <br /> marked and Iabeled)placarded,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 cedlfy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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) m a small ql lily generator)is true..— <br /> Gene r'sltg6eror 'ntedlT d Signature onfh Day Year <br /> P' 7 J8 <br /> 16.Interil1itional Shipments <br /> iEl mport to U.S. El Export from U.S. Port of en (exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedfTyped Name 5' Month Day Year <br /> I Lt Ake 13C,CR, Q17 <br /> Z 7ransporter Printedrry a Sig lure Month Day Year <br /> 18.Discrepancy <br /> 188.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue- ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 1Bb.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone'. <br /> Liu, 18c.Signature ofAltemate,Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Repo-1 Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 / 2. 3. 4. <br /> 20,Designated Facility Owl or Operator:Certification of receipt qLbaiwardous materials covered by the manifest except Wricted in Y11A. Alf <br /> Pnnted/lryped ame Signature M y Y <br /> EPA F�j87ffi(3Re�v13=Q5LP7rEwious editions are obsolete. SIGNATE F LITYTO TIN 10 STAME(IF EQUIRED) <br /> �r 1 1 fib! <br />