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SSL SK SHIPO 230196726 <br /> I ~ <br /> Please prin,"- _ Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS j1.GeneraIorIDNum1,, 2. age o 3. me�ge��y Respppse P}�q� 14.Manifest Tracking`Tracking Number �( <br /> I WASTE MANIFEST 0�1-160.36110'7 -t3N1rLi"4tr#9-'1/ �i ® T 276741 s�!� <br /> 5.Generator's Name and MailingAd dress Generator's Site Address(if different than mailing address) <br /> Mae Auto Repair <br /> 2255 5 Airport Way Attune Moe <br /> 1 STOCKTON CA 95205-33313 <br /> Gonerator'sPhone: SOS-x ""145 <br /> 'Tr9FWY m9W9nn4 SYSTEMS INC U.S.EPA ID Number TSf R00&��t$1205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> I <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S"EPA ID Number <br /> r <br /> t10012�1 JOSE <br /> ROAD nn � <br />� SAN .SQ�JE 9 I..Cr 95133 <br /> 409-441-0962 CAD@59494310 <br /> j Facilily's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Talar' 12.Unit 13.Waste Codes <br /> HM and Packing Group{ifany)) <br /> No, Typo Quantity WWaf. <br /> X 1 NA3077 HAZARDOUS WASTE SOLID., N.O.S. �l�i" � P D002 D006 D007 <br /> a s (L.EAb, CHROMIUM), 9, bG III � �-�- <br /> 4 I DOW, 181 <br /> � •tom-L��, ' - ` <br /> 3. <br /> 4 <br /> 14.Special Handling lnstructfons and Addilional Information TSD;;S3 81879011 M03E1$43 CSO.. (f <br /> v ` <br /> i)IwRGt*171 <br /> 24H EVIERO9NCYOBOO-468-1760-CHiSKITFI-Cc)ntract retain Icy gent rata ca"onfers a encyr,authority <br /> an initial tra sn •tnr to d or q stitui:e additin 1rA sn t s nn nonovIa .nr9shal-P, <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 Iabeledtplacarded,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 that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> 1 certify that the waste minimization statement Identifiad in 40 CFR 262.27(a)(f I am a targe quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneralceslOfferor's Pdn�yped Name Signature —� Month Day Year <br /> —1 16.rnterriaa0nel Shlpmenl5 <br /> p_, Eltmpod to U.S. ❑Export from U.S. Part of entrylexit <br /> 2 <br /> Transporter signalure(for exports only): Date leaving U.S.: <br /> W 17.TranspoderAclmowledgmentofReceiplofMate4als <br /> LLI <br /> Tran Her 1 PrinledMT d'Name Signature Month Day Year <br /> Z Transporter 2 Pd led/Typed blameSignature Month Day Year <br /> 16.DIscrepancy <br /> i8a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Li- Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Ganeralor) Month ,' Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � i f 2. 3. <br /> 20.Designated Faci ily Ownel or Operator.Certification of receipt of hazardW materials covered by the manifest except as fed in Item 1689 J <br /> PrintodlTypedName J Signature ' Month Day Year <br /> �t-�-r/_' �' fG �/' oar 61 <br /> EPA Form 8700-22 Rev.12-17) Previous edI la s E. S�03SIGNATED FACILITY TO GENERATOR <br /> 1)8764f if 1951193 a + �_ / <br />