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gc,L SK SHIP# 23108',*998 <br /> Form Approved,OMB No.2050-0039 <br /> Please print or typd"e 4.Manifest Tracking Number ��� <br /> 1 Generator ID Number - 2.Pa9ei of _3.�Eme an Re4s�o8 27� 001 <br /> UNIFORM HAZARDOUS _ CAL.800394668 <br /> WASTE MANIFEST 0;rel Genemlors Site Address ladreerent than mailingmurass) <br /> 5.Generators Name and Mailing Address <br /> D'Reilly 0 4719 <br /> 15079.5 Harlan Rd CA 95330-9802 <br /> LATHROP <br /> Generators Phone: 209-234-1895 us EPA IDNumber TXR88O8612O5 <br /> 6.Trans oder 1 Com any Name <br /> Trans SYSTEMS INC u.s.EPAIDNumber <br /> 7.Transporter 2 Company Name KADO39322250 <br /> -CLEAN HARBORS ENV SVC INC. u.s.EPAIDNumber <br /> B:Designated Facility Name and Site Address CLEAN. HARBORS SAN JOSE <br /> teal RYESSA ROAD <br /> SAN JOSEa CA 95133 CRD85949431O <br /> 408-441-0962 <br /> Fadktys Phone: 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> 9a. 9b.U.S.DOT Descnphon(including Proper Shipping Name,Hazard Class,ID Number, No Type Quantity WI.Nol. <br /> RM add Packing Group(if any)) DM 1 P 181 <br /> NOW NON-RCRA HAZARDOUS WASTE, SOLID, <br /> o (ABSbRBENT AND OIL), N <br /> a, 7 <br /> m <br /> 2 2. <br /> w <br /> c� <br /> 3. <br /> 4 <br /> 14,Speraal Handling lnsWchons TSDaSJ 82726677 ORi6176 93. <br /> tJIJ` <br /> trot retained by generator confern a eauthori y <br /> 24H £T4E, NCYM8OO-466-1758-CHISKITfI-Can by rs ppmgname. damclassfied, . <br /> 15:: GENERATOR'SWFFERGR'S CE A :(hereby declare tliat the cadenLs afNid mnsignmenl are fuNy and acarcalely desaihed <br /> .marked and laWdjplacarded,and are in all respects m Proper condi� transport o(� A 9 nt of6Consenl na6arial governmental regulaaons:fleWoil shiPmenRandlam the Primary <br /> Bpofter,I ce Nre caNenfs of this corrsgnn eri r conform C �y Y� <br /> that waste minimization statement Wartified'm 40 CFR 262.27(al(N I am a large 9centiN ) (b)(fit am a small quantity generator)s true. ay <br /> ty rs nt€drryped Name },`,�'} p v <br /> .. Vii l.R/'`� b(Vti' <br /> ElImport to OS. ❑Expotfrom U.S. Pod of enhyyexN: <br /> Date leaving U.S.: <br /> iTransporter signatum(for export only): <br /> W It.TmrsporbNAcknowimigment of Receiptof MateSignature Month Day Year <br /> 6iIraner owe typed Name <br /> O y Month DaY Year <br /> aZTa r Primer YPed Name Signa m 6 .. <br /> F . C .. 7 <br /> 18 Discrepancy T Residue ❑Partial RejkrAon ❑Full Refection 18x.Discrepancy Indication Space <br /> ElQuantity ElType ❑ <br /> Mandest ReferenceNumhen EPA ID Number <br /> i8b.Altemate Facility(orGenemtor) <br /> J <br /> V Month Day Year <br /> rai Facility's Phone <br /> W 18c.Signature ofAllemale Facility(erGenemtof) <br /> Q <br /> Z <br /> N 19.Hazardous Waste,R,/elrort Managemenf Method Codes.(i.e.,codes for hazardous waste treatmem.disposal,and recycling systems) 4 <br /> 2. <br /> 20.Designated Facility Owner or Operator Cedfikbatim of+eceipt of hazardous materials covered by the manifest except as ed in It 18a Day `y <br /> SgnaNre 2 <br /> Pnnted7 a z / /— L /1.7 <br /> . � C- /V�J� �i/Lc•+C�- OESI EOI,.AC0.1TY 7D GENERATOR <br /> EPA Foml 8700-22(Rev.12-17) Previous.editions are obsolete. <br /> 1}7361257/4055968, <br />