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SK SHIP# 229702845 Form Approved.OMB No.2050-0039 Please print or type. 4.Manifest Trackin Number 2.Page of 3. me�pe� R e P o ® 1 V V �((� UNIFORM HAZARDOUS t.Generator ID Number Cry ^"fk,7" i "� nu WASTE MANIFEST Generator's Si a Address(if different than mailing address) 5.Generators Name and Mailing Address Cherokee Freight Lines 5463 Cherokee Rd CA 95215--11P8 ST OCKTON Generato>s Phone: 1- 1-357 3 U.S.EPA ID Number c SYS*rEMS INC U.S.EPA ID Number 7.Transporter 2 Compan Name MAD039322250 CLE f RS ENV SVC INC. U.S.EPA ID Number 8 Designated Facility Name and Site AddressCI_E � BA SAN JOSE SAN JOSE g OAD CA 95133 -1:0059494310 408x-441--16%2 Facility's Phone: 10.Containers a 11:,Total 12.Unit 13.Waste Codes 9a 9b U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No. Type Quantity Wt.Nol. HM and Packing Group(if any)) 1 ------ NOWI LIN FCRA HAZARDOUS WASTE SOLIDS, PM P 352 p (SF tr1JUSTy CL..AYt AND OTLS), wP 2, NQN` RCRA HAZARDOUS WAST -, SOL.1 D � DM iD (OIL, FILTERS) 3. 4, 14.Special Handling Instructions and Additional Information TSD-.SJ 4H EMERS NCY#800-46eri760-C to /SK/FI-C ntrActtutedretjita red ral b� � ��arLer r_ nf�r agency �tt�tPtar y on iri;itiai trascribed above by 15. marked labeled/placarded,F d arCERTIFICATION:allrespe is inby declare proper condition for transport at the contents of ccording consignment are applicable ilnterna oral and national atonal gove nmentah egulations.lpIf export hipment and I am the Primary packaged, marked a Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Coisen. 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 generator)is true. Month Day Year Signature � �„— Generator'sl0fferor's Printedrryped Name s r. , 16.International Shipments Import to U.S. []Export from U.S: Port of entry/exit: Date leaving U.S.: Z Transporter signature(for exports only): 17.Transporter Acknowledgment of Receipt of Materials Signature Month By Year Transporter 1 PrintedtTyped.Name A p e 4 t `f¢ �^ Month Day Year Signature Z Transporter 2 PrintedlTyped Name 18 Discrepancy ❑Full Rejection 18x.Discrepancy Indication Space ElQuantity ❑Type ❑Residue ❑Partial Rejection Mar ifes'Reference Number: •� U.S.EPA ID Number 18b.Alternate Facility(or Generator) V Facility's Phone: Month Day Year LO 18c.Signature of Alternate Facility(or Generator) Q Z S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 W 1 2. C3 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifests teecep;as rated in Item 16a Month Day Year Printed/Typed Name GENERATOR'S INITIAL COPY EPA Form$700422 @ev,.12-,17� Previous e�%ion2�s16ISSM-ae I F,A77