Laserfiche WebLink
SSL SH SHIP#^2�484- II��IIIiII�I1IIII�IIIIII� I) <br /> Please print or type. 0 0 6 6 6 7 2 2 4 S K E <br /> Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CRL000433477 2.(,ef]3.Emery RQsppy a Phoant 1.Man fast Tracking Number <br /> WASTE MANIFEST 1 t3@@ 4bG 1/t 006687324 SKS <br /> S <br /> 5.Generators Name and Mailing Address Generators Ste Address(if different than mailing address) <br /> SReedco Truck Lube #338 99 At Jackstone Exit — <br /> RIPON CA 95366-0000 <br /> Generator's Phone: 209-599-7961 <br /> s.Trpaspytter�Co�nybapa SYSTEMS INC U.S.EPA ID Number <br /> bH�t Y 1SLtL(V TXRa00081205 <br /> 1.Transpoder 2 Compan Name U.S.EPA ID Number <br /> CLEAN 91AWSORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> Facility's Phone: SRN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> 9" 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. _Type Quantity W1.1VO. 13,Waste Codes <br /> 1. NON-RCRA HAZARDOUS WASTE, SOLIDDM P 223 <br /> o (OIL FILTERS) <br /> (� S fop <br /> Z 2. <br /> W <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Additional information TSD:SJ SP22107 CSG' <br /> 24H EMERGENCY#800-468-1760-CHfSK/TFI-Contr tOlretainedI bgenerator`Qco fer agSgency authori y <br /> on in transporter to add or substitute ditianal transporters on a er.Ear's behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accurately described above by the shipping name,and are classified,packaged, ' <br /> marked and laheledlplacarded,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 EPAAcImowledgment of Consent. <br /> I cer ify that the waste minimization statement identified in 40 CFR 282.27(0)(if I am a large quantity generator)or(I(ifI am a small quantity generator)is true. <br /> GeneratorslOffamrs Printe yped Narne C Signature Month Day Year <br /> `; ,� , --�, 1/-�41- a� <br /> J 16.International Shipments <br /> H Impon to U.S. ❑Export from U.S. Port of enbylexib <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporterAcknowledgment of Receipt of Materials <br /> W Tra orter 1 PrintedRyped N e Sign Month Day Year <br /> TLV i, aA 111 <br /> Z Transporter 2 PrintedlT ame gnature Month Day Year <br /> 18.Discrepancy Z� ` <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejech'on ❑Ful€Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL Facility's Phone, <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N <br /> 19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Lu p 1 * 2. 3. 4 <br /> 1 20.Designated Facility ner or f perator.Certs coiDn of receipt of rdous materials Dover the manifest except note in Ife <br /> Printedlfyp Na SignaNre Month D Ye <br /> EPA Form 8700-22((Rev.12-171 Previous editions a solete. 5DESI ATEDF LITY OEPA's e-MANIFEST SYSTEM <br /> 1)7612003E1;6777 <br />