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SSL SK SHIP# 232011468 IIIIIIIII III III <br /> 0064515245 K $ <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me n R se Ph 4.Manifest Tracking Number <br /> WASTE MANIFEST CALOLA0394668 1 - �-+�@-1�6�0 006951524 $K$ <br /> 5.Generators Name and Mailing Address Generators Site Address(IF different than mailing address) <br /> O' Reilly # 4719 <br /> 15079 S Harlan Rd <br /> LATHROP CA 95330-9802 <br /> Generators Phone: 209-234-1895 <br /> 6.T5nWETY'oT1TENM SYSTEMS INC U.S.EPA ID Number TXROOOOB1205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD@393-:Ds50 <br /> 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 SE CARPENTER DR <br /> Facllitys Phone: Cl_ACKAMAS s OR 97015-8988 <br /> 503-78B-4616 ORQ000025197 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(8 any)) 13.Waste Codes <br /> No. Type Quantity WLNoI. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID DM P 223 <br /> o (DRAINED/UNDP.AINED USED bIL FILTERS) <br /> z 2. <br /> W <br /> (9 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:TPO 83846661 OR16176a�=: <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers a er,cy aath0ri v <br /> on initial transporter to t r r' <br /> 15. GENERATOR'SnOFFEROR'S CERTIFICATION: I hereby deciare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacorded,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. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(HI am a small quantity generator)is true. <br /> Generat rots 'ntedrryped Name Signature Month Day Year <br /> CI g <br /> 16.InveloraltTitrFents <br /> ❑Import to U.S. ❑Export from U.S. Pan of entry/exit: <br /> = Transporter signature(for exports only): Date leaving U.S. <br /> K 17.TmnsporterAckn Iedgment of Receipt of Materials <br /> KTransporter Print yped me Signature Month Day Year <br /> a <br /> Z Transporter 2 PnntedlTyped Name n re Month Day Year <br /> 9 <br /> f <br /> I18.Discrepancy <br /> 18a.Discrepancy Indication Space 11Quantity ElType ❑Residue ❑Partial Rejection Dail Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> I Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <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 Owner or Operator:Cebfiwtion of r ceipt of hazardous tenets covered by them ifest except as ed in Item 18a <br /> Pdnted(fyped Nance S alure Month /Day Year <br /> b 61 LL w d <br /> EPA Form 8700-22 ev.12-17) Previous editions are obsolete, GNATED FACILITY TO EPA's a-MANI EST SYSTEM <br /> 1)7872679/156033 <br />