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SSL SK SHIP# 228639149 �I�i���lll�llh��llll�i� lllllll <br /> 006960Z335KS <br /> Form Approved.OIi No.2050-0039 <br /> Please print or type. 4.Manifest Tracking Number <br /> 1.Generator ID Number 2 Page t of 3.Emer ency Response Phone 9 SKS�^ <br /> UNIFORM HAZARDOUS CAL01D0207935 1 1-�00-468-1760 p 6 g 6 0 2 3 3 `V J <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Autozone # 3326 Autoznne # 3386 <br /> 123 South Ill Street 2309 W Hammer Ln <br /> MEMPHIS TN 38103 STOCKTON CA 95209-2367 <br /> Generator's Phone: 209-477-9788 U.S.EPA ID Number <br /> 6140 nems orter 1 Com any Name TXR800081205 <br /> 40TI Y—�CLEEN SYSTEMS INC <br /> U.S.EPA ID Number <br /> 7.Transporter 2 company Name MAD039322250 <br /> CLEAN HARBORS ENVIRONMENTAL SUC INC. <br /> U.S.EPA ID Number <br /> 8 Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE <br /> 10021JBERRYESSA ROAD CA 95133 <br /> 408-441-0962 SAN OSCAD059494310 <br /> Facility's Phone. <br /> 9h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 17.Totat 12,Unit 13.Waste Codes <br /> ga. No Tppe Quantity WLNol. <br /> HM and Packing Group(if any)) <br /> 0 1. NON RCRA HAZARDOUS WASTE SOLIDS, (SPEN j DM , fja P 352 <br /> r T CLAY ABSORBENTS) d <br /> z 2. <br /> w <br /> c7 <br /> ith <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD 7 SJ 80238683 AU24566 CSS 7 <br /> 24H EMERSENCY#800-468-1760—CH/SK/TFI—Contract retained by gene at peon ors a envy authori y <br /> 15. GENERATOR'SIOFFEROR'S CE TIFICATION:I hereby declare that the contents of this o�nsignmentare fully and accurately described a ve by the proper shipping name,and are classill nn ified,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 EPA Acknowledgment of Consent. enera or is true, <br /> certify net the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator or ''Ila mall quantity g ) Month DaYYY Year <br /> Generet9rsl0ffemirs Printoo Ty dNimep Slgnatu l <br /> � <br /> 16.International Shipm s ❑Import to U.S. ❑Export from U.S. Portof entrylexit. <br /> ZDate leaving U.S.: <br /> Transporter signature(for exports only): <br /> w 17.T of Acknowledgment ief Receipt of Materials M th Day Year <br /> T s r 1 Pnntedi ame Signal , <br /> a / <br /> MonDay Year <br /> S' ure (h <br /> Z Tr r2Ion pad Name 1(� <br /> W — ()— -A <br /> 18.Discrepancy <br /> ❑Residue Partial Rejection Full Rejection <br /> 18a,Discrepancy Indication Space 0 Quantity ❑Type ❑ <br /> Manifest Reference Number: <br /> U.S.EPA 19 Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> Facility's Phone, Month Day Year <br /> LOU 18c.Signature of Altemate Facility(ar Generator) <br /> a <br /> z <br /> h19.Hazardous Waste Repoli Management Method Godes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 2 3. 4 <br /> iLt1 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest apt as noted in Item I so Month Da Year <br /> P' ped Name Signatu �-` <br /> EPAForm8700-22((ReviiIz-117)Previousedonsareobsolete. DESIGNATED FACILITY T A e•MANIFESTSYST M <br /> 1)7361065/333549 <br />