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SSL SIi SHIP# III II f l II fI Illllllllllll If Ifll Ill I III -L� 110q �01 0 0 a 7 4 9 9 1 1 S KS Please print or type. Form Approved.OMB Nt2.2(150-0039 UNIFORM HAZARDOUS 1-Generator ID Number 2.Page 1 of 3.Erne cY Response Phone 4.D O TracloingNum�1 1 S KS WASTE MANIFEST CAL�01��1433477 1 1-8 -4ta19-1760 8 7 4 9 5-Generator's Name and Mailing Address Generators Site Address(if different than mailing address) Sgeedcfs Truck Lube and Tires - '944 115 Hoff Dr Hwy 99 1 2378/Jackton RIPON CA 95366--0000 Generators Phone: 209-599--7961 s.T94WW WL'k ve SYSTEMS INC U.S.EPA ID Number T x R000081205 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 .POSE U.S.EPA ID Number 1021 BERRYESSA ROAD ,. SAN 3OSE , CA 95133 408-441--0962 CAD059494310 Faciti s Phone: 98• 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Cordainers 11,Total 12.Unit 13.Waste Codes HM and Padding Group(if any)) No- Type Quantity WLIVol. 1 (DRAINED HAZARDOUSINED WASTE SOLID BN P 223 USED OIL FILTERS CONTAINING USED OIL 11a i 2. w C7 3- 4, 14,Special Handling Instructions and Additional Infmmation TSD:SJ SP25842 C5G 7 Fi EMERGENCY##800-468-1760--CHISK/TFI-Contract retained by generator confers a eTtcy authority 15. GiENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dasslfied,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.I(export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknoWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26227(a)(fi l am a large quantity generator)or(b)(if I am a small qua erator)is true. Generator Offerors PrintedlT ed Name Signature Month Day Year �(� � -z- 16.International Shipments ❑Import to U.S. ❑Export from UK Port of entryleraL ? Trarsporter signature(for exports only): Date leaving U.S.: W 17.TransporterAckravledgment of Receipt of Materials Transporter 1 PrintedCFyped Name Signature Month Day Year CIO Transporter PrintedlTyped Name Signature Month Day Y�r �I Z�1227 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partiai Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Faatity(or Generator) U.S.EPA ID Number C] Fadilly's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month {lay Year N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) f - `ILA` 2 3. 4. 20.Designated Fa ily Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Frill YPed�V� � �n ell— Signature av M jlh gay Year EPA Form 87OD-22 Rev.12-177�� Previous editions aVre sofete. D IG TED FACILITY TO EPA'S e-MANIFEST SYSTEM 1,)7612003/156777