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SSL SK SHIP# - <br /> ���� Illlil11110111111l111111111101111111111111101111l <br /> 0 0 6 1 3 5 5 3 7 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewnter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pae 1 of 3.Erne envy Res rase Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000352832 1-860--46�17601006135537 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 /> Gen mattpnras�Phone: 785-690-0109 <br /> 6SRFETY'KWMI�"N�SYSTEMS INC U.S.EPA ID Number <br /> TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL- SVC INC. MAD03932225N <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS OF WILMINGTON LLC U.S.EPA ID Number <br /> 1737 EAST DENNT STREET <br /> WILMINGTON , CA 90744 <br /> 310—A35-9998 CADIA44429�?3S <br /> Fadlitys Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Gomainars 11.70121 12.Unit 13.Waste Codes <br /> HM and Packing Group(it any)) No. Type Quantity Wt.Nol. <br /> rx 1"NON—RCRA HAZARDOUS WASTE, SOLID DM I J P 223 <br /> 0 (OIL FILTERS) <br /> 4a <br /> z 2. <br /> W <br /> ('J <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:WI GA15065 CSG: <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) ' ;M <br /> ALITH AS n _ n FAY GEN TO RETAIN LICENSED SUB CARRIER Ss <br /> 15. GENERATOR'S/OFFERORS CERTIFICATION: [hereby declare that the contents of this consignment are hilly and accurately described above by the pmper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in an respects in proper condition furtransport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contems of ties consignment wnform to the toms of the ffilached EPAAdmowledgment of Consent. <br /> I wrgfy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantitygenerator)or(b fi quantity generator)is tore. <br /> GeneralorsMemes Pdnle&Typed Name Signature Month Day Year <br /> v X ►1 In <br /> 16.International Shipi5 <br /> {— ❑Import m U.S. ❑Export horn U.S. ort of entrylexit: <br /> Z Transporter signature(tor exports only): Dale leaving U.S.: <br /> W 17,TnnspalerAcIveMefigment W Receipt of Materials <br /> Tre r i P" tedlryped No Signe Month Day Year <br /> �, tea; 07 ILI In <br /> z Transporter 2 Fri Name nature Month Day Year <br /> f4-.f z <br /> } 1B.Discrepancy <br /> 18e.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pargal Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Fadlays Phare: <br /> w IBc.Sgnahae ofAhenate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> C 1 2 <br /> 20.Designated Facility Omer or Operator.Certification of receipt of hazardous matenals covered by the man"except as noted in Ilam las <br /> Printed/fyped Name Signature Month Day Year <br /> ,,.,c 3 1 /7 <br /> EPA Form 8700-22(Rev..3-05 Previous editions am obsolete. SIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1)7612003/15677 <br />