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SSL SK SHIP# 232337242 11111IIIIM111I1IIII1I <br /> 0077668268 K.8 <br /> Please print or type. p� Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.GeneratorlD Number CAL000392916 2.Page of 3.jme R2jgoge I7t0 4.Manifest Trackin Number <br /> WASTE MANIFEST 0 0 7 7 6 8 2 6 SKS <br /> 5.Gb tiei3nlg and Maili2§r�ss Generators Site Address('ddiiferent than mailing address) <br /> 515 E Yosemite Ave <br /> MANTECA CA 95336-5837 <br /> Generators Phone: 209-239-4188 <br /> s'Tr9'AR1'fS"—gIl"L' SYSTEMS INC U.S.EPA ID Number TXROMOO81205 <br /> 7.Transporter 2 Com an Name U.S.EPA ID Number <br /> CLEAN HFl BORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> Facility's Phone: <br /> ga9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Packing Group('d any)) No, Type Quantity Wt.Nol. 13.Waste Caries <br /> 1 NON—REGULATED MATERIAL, (METAL BRAKE DF P NON <br /> o SHAVINGS) <br /> z Z. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Intonation TSD:SJ 84195367 OR14365 CSG: <br /> 'dcot__� 5-1103v <br /> 24H EMERGENCY#800-468-1760—CHJSKITFI—Contract retained by generator confers aggency autfiari y <br /> on initial transporter to add or substitute additional trans orters on eneratores behalf. <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and acamtely described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplaarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.t export shipment and I am the Pnmary <br /> Exporter,I codify that the contents of this consignment conform to the tenns of the attached EPAAcknrnMedgment of Consent. <br /> I artiy that the waste minimization statement identified in 40 CFR 262.27(a if I am a large quantity generator)or(b)(tl am a small quantity generator)is tme. <br /> Generatoral08erors Pnntedrryped Na Sign dare Month Day Year <br /> 16.International Shipments <br /> f ❑Import W U.S. ❑Expod tom U.S. Pot of entrylexit: <br /> ? Transporter signature(Por exports only): Date leaving U.S.: <br /> C 17.Transporter Acknowledgment of Receipt of Materials <br /> r T sporter 1 PnntedRyp�++ed Name Si Month Day Year <br /> z T er2PdnW1yped Name m Month Day Year <br /> 1 18.Discrepancy <br /> III Discrepancy Indication Spam ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> tai Facililys Phone: <br /> 18c.Signature of Alternate Facility(o Generator) Mond Day Year <br /> zz <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 6/! / 2. 3. 4. <br /> 41f20.Designated Facility Owner or OperatorWfiati receipt of hazardous ah' covered by the manifest ex ed in Item as <br /> illl S aY <br /> EPAF ¢2042 �r� 26 i viouseditionsaaobsolete. DESIGNATED FACILITY TO EPA's a-MA FEST SYSTEM <br /> 1) ( <br />