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SSL SK Sa�e?V <br /> F{IP#--227578 0"3' <br /> 0 0 6 1 0 0 6 3 2 S K S <br /> Please pent or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL00@352832 � —2.Pae 1 of E cykernq�% 4.Manifest Tracking Number WASTE MAN 1 <br /> O SKS <br /> 5.Generators Name and Mailing Address Generators Site Address If different than mailing address) <br /> Gardner Trucking/Classic Sales In, <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 785-690-0109 <br /> 6'4Aftf)—'WEeSYSTEMS INC U.S.EPA ID Number TXR@00081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SERVICES INC MAD039322250 <br /> e.Designated Facility Name and Site Address CLEAN HARBORS OF WILMINGTON LLC U.S.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> WILMINGTON , CA 90744 <br /> 310-835-9998 CAD044429835 <br /> Facilitys Phone' <br /> 9a 91b.U S DOT Descripban(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt,No1, 73.Waste Cotler <br /> z <br /> 'NON—RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> o (OIL FILTERS) I ' S d <br /> I <br /> iY <br /> L <br /> L 2. <br /> IL <br /> 17 <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Additional Information TSD:WI GA15065CSG; <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) I�� 0 S- <br /> AUTH AS "ASENT—FORa E BY GTO RETAIN LICENSED SUB CARRIERS AS NECESSARY <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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according 0 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 EPA Acknowledgment n. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)if I am a large quantity gene r b a 11 entity generator)is We. <br /> Gevne`rator'srOflerors Pnnted7Typed Name Sig u Month Day Year <br /> `� e <br /> —I 16.International Shipments <br /> r• ❑Import to U.S. ❑Export on of entrylexit: <br /> z_ <br /> Transporter signature far exports only):P° 9 ( P Y) Date leaving LLS.: <br /> U1 17.Transporter Acknowledgment of Receipt of Materials <br /> lm porters PrintedlTyped aSign Month Day Year <br /> U5 0 N0 t <br /> a: <br /> �I <br /> Z: Transporter2 Printed tl Name ure Month Day Year <br /> ~ G-J <br /> t18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partlal Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ua- =acility's Phone: <br /> w 18c.Signature wMemaw Faculty(or Generator) Month Day Year <br /> a <br /> IZ <br /> in '19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and pos recyding systems) <br /> 'I. it 2. <br /> T.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printecirfyped Name Signature Month Day Year <br /> EPA Form 8700-22they.3-OS Previous editions are obsolete. DESIGNATEDiPAtILEfYTO DESTINATION STATE(IF REQUIRED) <br /> 1) 7612003/156777 <br /> . w <br />