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SSL SK SHIP# 226427674 111111111 111111111 <br /> 0 0 6 3 9 1 7 7 3 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Fort Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pa f me R e P 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL00020793500.6391773 SKS <br /> 5.Generators Name and Mailing Address - GeneretoYs Site Atltlress(d different than mailing address) <br /> Autoxone # 3326 Autoxone # 3326 <br /> 123 South Front Street 2309 W Hammer Ln <br /> MEMPHIS TN 38103 <br /> Generators Phone: 209-477-9788 STOCKTON CA 95209-2367 <br /> 6.Trtfl?yt+�mVN SYSTEMS INC U.S.EPA ID Number TXROOOO81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.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 /> 408-441-0952 CADO59494310 <br /> facility's Phone: <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM <br /> and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> NON RCRA HAZARDOUS WASTE SOLIDS, (SPEN DM 3CX�l P 352 <br /> o T CLAY ABSORBENTS) �^ <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD.-SJ 778746$2 A[I24566�tygenerator <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract rota ed confers a en�y authori y <br /> on initial transporter to add or substitute i ' orters <br /> 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 dassified,packaged, <br /> marked and labeled/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 certify that the contents of this consignment conform to the terms of the attached EPAAcknoWedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 GFR 262.27(a)(if 1 am a large quantity generator)or(b)(ff I am a small quantity generator)is true. <br /> G ,mtorsl0fferors PrintedRyped - Signature Month Day Year <br /> -CYi x R /o 18 <br /> 16.IrTternational Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Traer 1 Pnnted d Name Signatu Month Day Year <br /> CL <br /> CL <br /> ' /0 C�S <br /> a Transpo Pd edrryped Name SignaNre Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type <br /> ❑Residue ❑Pallial Rejection 0 F Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facility's Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a .. <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. / 2. 3. 4. <br /> 20.Designated Facility ner or 0 rotor:Certification of receipt of h rdous materials cove by the manifest except pled in It <br /> Pdnted/ry d Name SignaWre Mo Day Year <br /> EPWl giof&9e/33Q5]Wouseditionsareobsolete. tGNATED FACILI TO DE NATION 9TATE(IF REQUIRED) <br />