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SSL SK SHIW2298-156:32 <br /> Please print or type Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number2.Page 1 of 3.pm R s e P 4.Manifest Tracking Number <br /> WASTE MANIFEST GAL000394668 1 1 1/btl 1007313377 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> O' Reilly M 4719 <br /> 15079 S Harlan Rd <br /> LATHROP CA 95330-9802 <br /> `Generators Phone: 209-234-1895 <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> SAFETY—KLEEN SYSTEMS INC TXR000R81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. HAM39322M <br /> '8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 21ERRRYESSA ROAD } CA 95133 <br /> Faeil Is Phone: 408-441-0962 SAN J CAM9494310 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group if an Quantity W WoL 13.Waste Codes <br /> -HM 9 P( Y)) No. Type H <br /> 1 <br /> w —*0 NON—RCRA HAZARD __-iSTE, SOLID, DM P 181 <br /> (ABSORBENT AND OIL? xrs+�/ <br /> z z. <br /> w <br /> co <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> TSDaSJ 81472819 OR16176 /�(} CSB: <br /> 24H EiREgt Y#800-468-1760-CH/SK/TFI-Contract retained b eniliQa odt4 authori y <br /> 15Dn;E . I 8111Lie & el <br /> marked and labeledrofzcarded,and are in all respects in proper condition for transport according to applicable international and national govemmeinal regulations.ff export stiryment and I am the Primary <br /> Exporter,l certify th contents of this consignment caMomi to be terms of the attached EPA Acknowledgment of sent. <br /> t,mrtify Nat the mininfuaticn sta nt identified in 40 CFR 26227(a)(8I am a large quantity gerarafor)or(b 1 am a small quantity is true. <br /> Generator mrtedff it SgraWre Month Day Y M. <br /> / Z <br /> 16. ems ' r <br /> ❑hdpod to.U.S. ❑Ep ft from.U.S. atafentryleat <br /> ? Transporter sgnaNre(tor exports only): Date leaving U.S.: <br /> w 17.TransporferAcknowled*nt of Receipt of Materials <br /> Tr nsporter 1 Prin12d/T Name Sg Monty Day r <br /> a Cn <br /> zZZ <br /> Sport P' yped Name Monty Day Year <br /> 9 t-�lf — o z9 l4 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mankest Reference Number: <br /> r 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) <br /> Monty Day Year <br /> Q <br /> 2 <br /> 0 19.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 Owner or Operator:Certification of receipt of hazardous materials revered by the manliest xcept as acted in Item 18a <br /> Print ame ` r ` Signa Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGN T CILITY TO GENERATOR <br /> 1)7361257140559685 <br />