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SSL SK SHIP# 226423483 - IIIIIIIII'IIIIII�IIIIIIIIIII'I�IIIII) 006391743SK5 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) - Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page of 3. me R e P 4.Manifest Tracking Number WASTE MANIFEST CALO00352832 3 —��— ��—Tato 0 0 6 3 917 4 3 SKS 5.Generator's Name and Mailing Address Generator's Site Address(ff different than mailing address) Gardner Trucking/Classic Sales In 2577 W Yosemite Ave MANTECA CA 95337-9641 Generator's Phone: 209-249-3204 6.Trtg PTKyy SYSTEMS INC U.S.EPA ID Number TXROOOOB1205 7.Transpoder 2 CompaName U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. WADO39322250 8.Designated Facility Name and She Address CLEAN HARBORS SAN JOSE A ID Number 1021 BERRYE5SA ROAD 408-441-0962 SAN JOSE CA 951.33 f Facility's Phone: CAD05449431O 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) No. Type Quantity M.Nol. 13.Waste Codes K 1. NON-RGRR RZARDOLIS WA5TE, SOLID �� DM 0 P 223 o (OIL FILTEERS) rag w X 2. w 3. 4. 14.Speaal Handling Instructions and Additional Information TSD:SJ 77728038 BA15065 CSG: 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by ge )e �r�coPer�s a n on initial transporter to add or substitute additional Iran orters on s behalf. 15. GENERATOR'SIOFFEROR'SCERTIFICATION: Thereby declare that the contents of this consignmentenerator'cy ahlori y consignment are fully and accurately describe above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable in in tional an national vemmental regulations.If export shipment and am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 0 n I cenify that the aste minimization statement identiliin 40 CFR 262.27(a)(if I am a large quantity generator)o (b) f a sm miry generator)is true. Generatoes/OfferoPr ted/fyped ame Signature Month Day Year J 16.International S s = Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): DatQ leaving U.S.: CC 17.Transporter Acknowledgment of Receipt of Materials OTrationeri PrintedlTyped me O Signature OF Month Day Year y \] 1 T iter 2 Printed/Typed Name Signature Month Dit I a Year oce 1 151 } 18.Discrepancy q 18a.Discrepancy Indication Space El Quantity El Type ❑Residue ❑Partial Rejection El Full Rejecfion 181h.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number J U LL Facilitys Phone: 18c.Signature of Atemate Facility(or Generator) Month Da r z Y z � N19.Hazardous Wast Report Man gement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w O 1 4W 1 2. 3. 4 1 20 Designated Faci i r or Operator r fication eceipt of hazardous materials covered by the man este pt a ed in Item 18a P tedRyped Name ,,`` Sgnatum M �g7 �p V" EPAF) 1bl�IDb�e/vl Pnyiousedi n a solete. D SIGNATED FACILITYTO DESTINATION STATE( r—own D)