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SSL SK SHIPa8�6 �1tI�I�I'IIF��l1I�11I1�'IIl'�II� <br /> h 0066E 73268 K8 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1-Generator ID Number 2.Page 1 of 3. me R s e P 'rfest Trackig Number �� <br /> CAL000433477 1 -� - �01""6066'87326 <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Reedco Truck Lube #338 <br /> 99 At Jackstone Exit - <br /> RIPON CR 95366-0000 <br /> Generators Phone: 209-599-7961 <br /> r�0�ppr�r3�om�n��i� U.S.EPA ID Number <br /> SYSTEMS INC TX R000081205 <br /> s.T7FIYtIY—C.C.�tfV <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name MAB0393^e2250 <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 HERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAU059494310 <br /> Facility's Phone <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a' <br /> HM and Packing Group(if any)) No, Type Quantity WtNol. <br /> NON-RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> o (OIL FILTERS) 0 } �o <br /> Z 2. <br /> W <br /> c� <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional information TSD:SJ SP22107 CSG: <br /> 24H EMERGENCY#800-468-1760--CH/SK/TFI--Contract retained by generator corifis�gency authori y <br /> an initial transporter to add or substitute additional trans orters on enera or' ha f. <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 Iabeledlplacarded,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 EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity,generator)or(b)III am a small quantity generator)is true. Month Year <br /> Generate IOfferor's Pdntedlfyped Name Signature <br /> 01 <br /> 1 <br /> 1.Inte ationa S menls ❑Import re U.S. ❑Export from U.S. ort of entrylexit. <br /> I.— <br /> Date leaving US.: <br /> Transporter signature(for exports only). <br /> W 17.Transporter Acknowledgment of Receipt of Materials Si Month Day Year <br /> T porter 1 P intedlTy Name <br /> O 1 <br /> 0. Month Day Year <br /> N Tr s orter 2 Pn JIT ped NameiQuatity <br /> ure <br /> T,,.�1M�18.Discrepancy <br /> 18a.Discrepancy Indication Space Residue Parbal Rejected Full Rejection <br /> ❑ ❑TYPe <br /> Manifest Reference Numhec <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> LL Facility's Phone. Month Day Year <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> 4 <br /> 2 <br /> � 19.Hazardous Waste eport Maria ement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems <br /> N 2 3. 4. <br /> 0 1. <br /> 20.Designated Facility 0 n or Operator.Ced cation of re of hazardous materials covered by the manifest except a i Item 18a _ <br /> Signature tj`T(�J/"�y <br /> Printedlfyped Name <br /> 80- Rev. vious edi ns at clete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> EPAForm 70 22 e <br /> 1)76 567 7 <br />