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— --* SSL SK SHIR# Milo- ✓v—`i IIII� III�I(II' IIIIII 'illl�i' <br /> 006391729SKS <br /> Please print or type.(Form designed for use an elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page of 3. me R e P 4.ManiTraking Number <br /> CAL000433477 i -�� - -f7g0 066"391729 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> S eedcv Truck Lube #338 <br /> SR 99 At Jackstone Exit — <br /> RIPON CA 95366-0000 <br /> Generators Phone: 209-599--7961 <br /> 6.T%1jrrtJp2K,&% SYSTEMS INC U.S.EPA ID Number TXROOOOB1205 <br /> 7.Transporter 2 Compan Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> B.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> CAD059494310 <br /> 408-441—.0962 <br /> Facility's Phone: <br /> ge 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 Quantity WLN01. 13.Waste Codes <br /> 1 NON—RCRA HAZARDOUS WASTE, SOLID DM Jw P 223 <br /> p (OIL FILTERS) �Y <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD14U 77872250 SP22107 CSG: <br /> � rjU�3a�1�q <br /> 24H EMERGENCY#800-468-1760—CH/SKfTFI—Contract retaine� by generatar confers aggency authori y j <br /> an initial transporter to add or sub tute additional trans vrters on eneratvl behalf. ' <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents'' consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labelediplacarded,and are in all respects in properocndition for transport according to applicable international and national governmental regulations.If exportshipment and I am the Primary f <br /> Exporter,I certrfy,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)(KI am a small quantity generator)is true. <br /> Generator rocs PrintedlType a Signature Momh Day Year <br /> 0 �wGs All I-W3 <br /> J 16.International Shipments - I <br /> t_ ❑tmpod to U.S. ❑Export from .S. Porto rylexit: <br /> z Transporter signature(for exports only): D leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> Transport r1 PdntetllTyped Nam Signatur Month Day Year <br /> 0 <br /> QT iter 2 Pnintedirtyped Name Signa on Day Year <br /> CZr <br /> F <br /> t.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V j <br /> uQ. Facility's Phone: °s <br /> Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year ' <br /> N19,Hazardous WasteVapor[Mana menl Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2. 3. 4. <br /> t <br /> 20.DesignatedFacl eror Operato Carilip f receipt of hazardous materials covered by the manifest except as noted Ite 1Be - 1 <br /> Printed/Typed Nam `L Signature see <br /> { <br /> EPF�F)or 6,0j6 P7rewiouseditionsareobsol te. DESI NATED FACILITY TO DESTINATION STATE tIF REQUIRED) <br />