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SK SHIP# aReS' IIIIIIIIIIIIIIII mill 1111111111111 <br /> 0 0 6 0 9 9 9 6 9 S K 3 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0035 <br /> UNIFORM HAZARDOUS 1,Generator ID Number t 2.Page 7 of 3IEm¢rgipcv ReSpppse Pfwpe� 4.Manifest Tracking Number <br /> CA 9993s�a ` 1 tYP[ $Co 1!C <br /> WASTE MANIFEST 1 006099968 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> t ,srdner Trracjing/C1asS1C Sale, In <br /> W `Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generator's Phone. 785-690-0109 <br /> s.TawMe�-tC° e SYSTEMS INC U.S.EPA IO Number T x C;000081 �135 <br /> ��Yt Y <br /> 7.Transporter 2 Com an Name U.S.EPA ID Number <br /> CLEAPJ H�R,I ENVIRONMENTAL SERVICES INC I MAD9.'9 cc ':A <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS OF WILMINGTON LLC U.S.EPA to Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON , CA 90744 <br /> 31 t?-8'5-9998 LA�n9444c953'1 <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 /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON—RCRA HAZARDOUS WASTE, SOLID DM P .'23 <br /> C5 (OIL FILTERS) a �� <br /> .� <br /> o� <br /> :4 2. <br /> u] <br /> 0 <br /> 3, <br /> 4. <br /> 14.Special Handling Instructors and Additional Information TSDaWI GA15065 CSG: <br /> 24 HR EMERGENCY #1-890-468-1760 (Si f TFI) �]C/.J� ]�( <br /> RUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS�NECESSAR� 1 <br /> 15. GENERATOR'SIOFFEROR'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, 'I!. <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.N expert 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 cabby that the waste minimization statement identified in 40 CFR 262.27(a)If I am a large quantity generator)a a small quantity generator)is true. <br /> CenemtoeslOfferoes Printed Typed Name Signaw Month Day Year <br /> C� .. L r S 51 111 <br /> _a 16.International Shipments <br /> f- ❑Import to U.S. ❑Export from Pat of entrylexit: <br /> == Tr ansporter signature(for exportsonly): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> p: <br /> Tr44porter I Printedrryp Name Si Month Day Year <br /> - <br /> ao <br /> 2: Trans Printed/Typed Name gnature J Month Day Year <br /> 1 <br /> 6 1 Z42 <br /> 18.Dis ncy <br /> Ills.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑PaNal Rejection ❑full Rejection <br /> Manifest Reference Number: <br /> t: 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> .i <br /> CI <br /> u: Facility's Phone: <br /> ui 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a: <br /> z: <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and reading systems) <br /> ci 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 1111 <br /> illl Pdnted/Typed Name SignaWre Month Day Year <br /> �rrASto A �IrC 6 To }l <br /> EFA Form 8700-22�Rev.3-05 Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED; <br /> 1!? ;c09 115677 <br />