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SSL SK SH I P# '149838 IIIIIIiI 11 ll!IIIIIIIIIIf lI illl i iN 111 <br /> 0 0.5 2 4 4 7 8 9 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number �AL000�399�0 2.Page 1 of 31EnykrAegr"YResppnsehouet 4.Manifest Trackin Number <br /> WASTE MANIFEST 1 +�QIJ ''++bbttSS�— bb�IUU 0 05244789 SKS <br /> 5.Generators Name and Ma"ing Address Generators Site Address(if different than mailing address) <br /> Stockton Honda Yamaha Sead <br /> 3295 N Ad Art Rd <br /> STOCKTON CA 95215-2200 <br /> Generators Phone: 209-931-7940 <br /> 6. otCLr tN e SYSTEMS, INC, U.S.EPA ID Number TX R000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE LLC U.S.EPA ID Number <br /> 102'1 BERRYESSA ROAD <br /> SAN JOSE CA 95113-3 <br /> 408-441-0962 CAD059494310 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(d No.any)) 13 Waste Codes <br /> Type Quantity WWoI. <br /> 1- NONE.- NON RCRA HAZARDOUS WASTE SOLIDS, DM P 512 <br /> o (EMPTY L►RUMSI, N/A I I <br /> � t <br /> i <br /> W <br /> - " 1wi —I— <br /> .- <br /> 3. <br /> JAN 11 2 , <br /> 4- <br /> 14. <br /> 14.Special Handling Instructions and Additional Information TSD.-SJ 69196801 ST27754 CSG: <br /> 24 HR EMERGENCY #1-8+00-468-1760 (SK / TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'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 classified,packaged, <br /> marked and labeled/placarded,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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(dl am a small quantity generator)is true- <br /> GenRZr`sjOffeQa#jal#d1Typed NgwA Sjgqr Month DaYear <br /> —j 16.International Shipments <br /> ~ ❑Import to U.S. Export from U.S. Port of entry/exit: <br /> Z Transporter signature(for exports only): Dale leaving U.S.: <br /> rai17.Trans erAdmoWedgrnent of Receipt of Materials <br /> Transpo er 1 rintedfTyped Na �( Signature Month Year <br /> 0- J I�d A <br /> Q <br /> TransWrter2 Printa I y Nah ie oSignature Month Day Year <br /> H <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Parlial Rejection .❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> tn- <br /> N 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Uj 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EP Fv/� 820T.13 Mnious editions are obsolete. DESIGNATED FACILITY TO DESTINATION S I�4TE(IF REQUIRED) <br /> c• _ <br />