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SSL SK SHIP# 230581767 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me Rgs se Ph7 14.Manifest Tracking Number WASTE MANIFEST CPLMM2984 1 `►��-1 f 007275473 SKS 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) O' Reilly # 3222 1200 W Lathrop Rd MANTECA CA 95336-96.10 Generator's Phone: X09-239-9606 6."91 Y W SYSTEMS INC U.S.EPA ID Number T X ROOOOB 1205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENV SVC INC. MAD039322250 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number 1021 BERRYESSA ROAD SAN JOSE , CA 95133 CAD059494310 408-441-@962 Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1 -N9NE N-RCRA HAZARDOUS WASTE, SOLID, DM P !81 0 (ABSEIRBENT AND OIL),-A4-C> Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information TSD i SJ 82288354 OR10542 CSG 24H EME-RGENCY#8010-468--1760-CH/SK/TFI-Contrar-t retained by generator confers agency authori y I initial transporter to add or substitute1 transporters on generator' s behalf. 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 classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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. Generato /Offerors Printed/Typed Name Signatur Month Day Year o I ) t rn c i<�.� a� t, 16.Interna nal Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLI Tra orter1 Pri ted/Typed Na Signa Month Day Year a ��. � Z Trans rintegdl4ped Name atur Month Day Year 18,Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Wa_tq Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. ILI 20.Designated Facility OOK or Operator: ertifi tion receipt of hazardous materials covered by the manifest except as n di Printedrryped Name Signatur -" _ _ A�Qpii� D Year EPA Form 8700-22(Rev-71-17) Previo are obsolete. DESIGNATED FACILITY COPY I)73fiAw 0909POS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.