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SSL SK SHIP# 224326329 (I�III�I1IIIImilli IIIIIIINIII <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 0 0 6 1 0 1 3 1 9 S K S <br /> UNIFORM HAZARDOUS 1.Generator ID Number Form Approved.OMB No.2050-0039 <br /> CRL000352832 2.Page lot 3.E moryen y Response Phone 4.Manifest Tracking Number <br /> WASTES Name and <br /> 1 1-81D0-46tl-1760 006101319 SKS <br /> 5.Generators Name and Mailing Address <br /> Gardner Trucking/Classic Sales In Gene cors Site Address(if ointment than mailing address)) <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 785-690--0109 <br /> 6SrAFPETY_WEE <br /> EN eSYSTEMS INC <br /> U.S.EPA ID Number <br /> 7.Tmnsporter2 Company Name rxR000081205 <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address MAD039322250 <br /> CLEAN HARBORS OF WILMINGTON LLC U.S.EPAIDNumber <br /> 1737 EAST DENNI STREET <br /> _ WILMINGTON , CA 90744 <br /> Facility's Phone: 010-835-9998 <br /> CAD044429835 <br /> ga. 9b.LLS.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit <br /> NON—RCRR HAZARDOUS WASTE, SOLID <br /> No. Type Quantity Wt.Nol. 13.Waste Codes <br /> z 1 <br /> (OIL FILTERS) ' DM P 223 <br /> 2 X56 <br /> W <br /> t7 <br /> 3, <br /> 4. <br /> 14.S, Handling Instructions and Additlonal Information <br /> TSD:WI 75566954 GA 15065 CSG: <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) ��10 IrFhl ' (121W <br /> r _ V <br /> 15. GENERATOR and la S/oFFEROR'S CERTIFICATION:a,CAnON: Thereby 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 labeletl/placertled,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 Nat Ne 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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity <br /> Generdtors/Offerors Pnted^/fynpewo Name [A ' q ty generator)is We. <br /> V l V - signature Month Day♦ Year <br /> 16.International Shipments ❑ ^ 01 0--1 '� <br /> ~ port to U.S. V <br /> Transporter signature(for exports only): ❑Export from U.S. Porto entry/exit: <br /> ,Ey 17.Transporter Acknowledgment of Receipt of Materials Date leaving U.S.: <br /> ix Tm orter 1 Pdn Yped Na <br /> 0 S <br /> _ _�� Month Day Year <br /> Tre s Printed/typed Name , S 0'll ( <br /> e <br /> rte— Month Day Year <br /> } 18.Discrepancy <br /> I 18a.Discrepancy indication Space <br /> ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> J U.S.EPA ID Number <br /> U <br /> LL Facilitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> iMonth Day Year <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,cod for hazardous waste treatment,disposal,and recycling systems) <br /> W <br /> G 2. <br /> 1"(k N ) 3. 4. <br /> 20.Designated FadlityOwner or Opemtoc Certification of receipt of...ZardoUa materials covered by the manifest except as nded in Item 1� <br /> Printed/Typed Name <br /> J ot-\L,r^, Signature <br /> �� w—� Month Day Year <br /> EPA Form 8700-22(Rev.3-05 Previous editions are obsolete. I Z S ( <br /> 1)7612003/1 56777 DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) 1 <br />