Laserfiche WebLink
SK swpo-eeeeirpwv� <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) - Farm Approved.OMB No.2050,0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page i of 3.Emergency Response Phone 4.^Manitesl Trackin Number (t <br /> WASTE MANIFEST Cf 0352032 1-800-468-1760 ' /Q. ' 29097. . SKS <br /> 5.Generators Name and Mailing Address Generstots Site Address(H ditmnt than mating address) <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY—KL.EEN SYSTEMS, INC. TXR0Q108 lM <br /> 7.Transporter 2 Company a U.S EPA ID Number <br /> 8.Designated Facility Name am Nm Address CLEAN HARBORS OF WILMINGTON LLC US.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON It CA 90744 <br /> Fadiiys Phone: �31.0^835-3998 CAD044$29835 <br /> 9a. 9b.U.S.DOT Descdption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unb 13.Waste Codes <br /> HM and Packing Group(ffany)) No. Type Quantity WtNal. <br /> 1. NON—RCRA HAZARDOUS WASTEy SOLID D14 !0 223 <br /> a (OIL FILTERS) <br /> m <br /> Z 2. <br /> W <br /> 1 <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Additional mfonnation TSD a WI SA15065 C3(/`7;�.,�j f <br /> 24 HR EMERGENCY N1-800-468-1760 (SK / TFI)AU: `¢ <br /> n n <br /> 15. G ERA ER R'S CER :I ereby d re e cmtents H �scenstgnmeM ere y an accurate sort proper s ipphg name,arti are classified,packaged <br /> CARR <br /> marked and labelediplacarded,and am 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 consgnmant conform to the tains of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(RI am a small quantity generator)is true. <br /> Generatot Offerors Pdnted)Typed a Signaatu Month Day. Year <br /> c5 n-� 1 �1/G r , Z X {� 1 4 <br /> —1 16.International Shipments <br /> F. ❑Impodic U.S. Export from U.S. - Pod of entrylexlt <br /> z. Transporter signature(for exports only): - Date leaving U.S.: . <br /> 17.TransporterAcknowledgmern of Receipt of Materials <br /> T rler 1 Pq''ted/ryped t Month Day. eVw— <br /> QTransporter 2 Prin ped Nam BlIgnature Month Daayy. Year <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial.Rejection ❑Ful Rejection <br /> Manifest Reference Number. <br /> 180.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> V5 U.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treahnent,disposal,and recycling systems) ' <br /> o :l. 2. 3. 4. . <br /> 20.Designated Facility Owner or Operator:Certification of receipt M hazardous materials covered by the manifest except as noted in I <br /> Printedrryped NameSgnakure Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> 1)7612003/156777 <br />