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SSL S1' SHJP* 2226486305 <br /> 0067775026 KS <br /> r Form Approved,OMB No.2050-0039 <br /> Please print or type. --.. - <br /> 1.Generator ID NumtiCr CAL000433477 2. ManifeslTraeWn Number n <br /> UNIFORM MANIFESTS n n 6 7 7 5 0 2 SKS <br /> WASTE MANIFEST <br /> 5.G erator's ame a Mailin d ess Generators Site Address(if different than mailing address) t <br /> °peeaco rU be #338 <br /> SR 99 At Tackstone Exit - <br /> RIPON CA 958£6-000$ <br /> 2$9-599-7961 <br /> Generators Phone, <br /> s.T�FiPP4°Off SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> U.S.EPA ID Number MAD$39322250 ' <br /> 7.Tr�,sppttP,r2 cgR7baaY.lJa(q@5 ENVIRONMENTAL SVC INC. <br /> 8.Designated <br /> Facility Name and Site Addre BURS SAN JOSE U.S.EPAID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 4$8-441-0962 CAD059494310 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total. 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity W1.Nol ., <br /> _ WASTE, SOLID DIM v 223 <br /> (OIL FILTERS) <br /> o "f `p <br /> z 2 <br /> w <br /> (J <br /> 3. ' <br /> 4. <br /> 74.Special Handling Instructions and-Additional Information W-1J/ q � <br /> 24H EMERGENCY#80$-468--1760—CH/SK/TFI—Contract retained by gener rlJconfers aQ agr Ii y <br /> on initial transporter to add or substitute IdditiDnal nsporters on generator's be alf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately descnbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplararded,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 1 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)it I am a large quantity generator)or(b if am a small quantity g rater)is true. <br /> Generators emrs PnntedlTyped Nam Signature Month Day Year <br /> 16.Internation-aT51pintents Import to U.S. ❑Export from U.S. Po entrylexit: <br /> ? Transporter signature(for exports only):. Date lea'ng U.S <br /> LK 17.Transporter Acknowledgment of Receipt of Mate <br /> Transporter 1 Printped Na a Signature Month Day Year <br /> o15- L� � 11 11 10 2LO 6 <br /> V3 Transporter 2 Pnnled ame Signature Month Day ;ear <br /> I— <br /> t8.Discrepancy <br /> 18a.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 t, <br /> J <br /> U <br /> LL Facility's Phone: <br /> 18c.Signature of Altemate Facility(or Generator) - Month Day Year - <br /> a <br /> z <br /> G19.Hazardous Waste Report Management elhod Codes lie.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Gr1. 2. 3. 4. <br /> 20.Designated Facility Cyner or Operator Certification of receipt of ardous materials cove d by the manifest exceptilioloted in a <br /> Il PnntedlTy ed Name Signature Month Day Year <br /> D/ <br /> EPIJ7 { )Y. DATEgF� � eITYTOEPA's e•MANIFESTSYSTEM <br />