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SK SHzP#T9WrVM" <br /> -n <br /> Please pant or type. " 1, Form Approved.OMB No.2050-0039 i <br /> UNIFORM HAZARDOUS i Generator ID Number 2.Page 1 of 3.Emer�,en,,c(Resoonsz Phone - 4.Manifest Tracking Number <br /> 00 f <br /> WASTE MANIFEST CAL028II+645 1 1- 45$-1760 9 22.07 S�[Q <br /> 5.Generator's Name ane Mailing Address - Generators Site Address(if different[ban mailing address) /KS <br /> Ryder T/S 1971 <br /> 3533 Duck Creek Dr <br /> ST TON CA 95215-7953 <br /> Genemtoes Pli 209'943-321$ <br /> 6.Trans orter'.Com an Name U.S.EPA iD Number <br /> Sf�FETY'-�{L�EEN SYSTEMS INC TXRN@081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number 3 <br /> CLEAR HARBORS ENVIRONMENTAL SVC INC. MAD039322258 <br /> - 8.Designated Facility Name and Site Address LEAKHARBORS .S.EPAID Number <br /> Sea-mss- <br /> Facility's Phone. - <br /> ga. 9b.U.S OOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM sand Parkin Gro ;if any)) 13.Waste Codes <br /> No. Type Quantity WLNci, <br /> NE N-RCRA HAZARDOUS WASTE, SOLIDS DM P 352 <br /> (DIESEL PARTICULATE FILTERS), ItM ?LU <br /> �( <br /> z z. <br /> w { <br /> 3. <br /> i <br /> 1 <br /> 4. <br /> I <br /> 14.Special Handling Instructions and Additional Information TSD je ` 80598713 RY 12021 CS8 t <br /> ^�� 11\9L-I <br /> 24H EMERGENCY#800-466-1760-CH/SK/TFI-Contract retained.ii by generator e,nfers a ency authori y <br /> Ad 76. GENERATOR'SlOFFEROR'S Gtin initial ERTIFIDATION:Thereby deGare±hat the ce tents of this consignment art fully and accurately described above by the proper shippin name,and are classified,packaged, .4 <br /> marked and la beledfplacarded,and are in all respects in proper condition for transport aafoNing to applicable international and national governmental regulations.If axpprt shipment and lam the Primary <br /> Exporter,I certify that the 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 targe quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genera lOffercrs Pi ecli ped Na Signature Month Day Year <br /> 16.International Shipments ' <br /> I- ❑Import to U.S. ❑Export born U.S. Port of tryiexit: _ <br /> ? Transporter signature(fQf exports only): Date l ing <br /> LU T . <br /> 17 <br /> CK Receiptof 'als l <br /> Transp e 1 Pdntedryp ame Signatu Month pay" Year t <br /> a ! <br /> rn1 <br /> rtd1r. [Typed i Si re Mo�j i <br /> > 3 p�l y IN 1 <br /> 18.Discrepancy - <br /> 18a.Discrepancy Indication Spax I <br /> - 1:1 Quantity El Type ❑Residue ❑Partial Rejacdon ❑Full Refection ' <br /> i <br /> Manifest Reference Number: <br /> 18b-Alternate=acility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phore: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year, <br /> Q <br /> 2 <br /> Z15 19.Hazardous Waste e rt Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and meyding systems) <br /> 0 1. 2. 3. 4. I <br /> 20.Designated Facility net or Op r.c Certification of rpVeeptoi h s mVenals covered by the manifest exceot as noted in it t <br /> PrintedlTyped Name Signature on - j <br /> EPA Form 8700.22(Rev.12-17)Pre s pions are bsolet. DESIGNATED FACILITY COPY <br /> 1)8fifi# K IS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e•MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE. <br />