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SSL SK SHIP# 226887645 III I��I'I�I�I��IIIIII III III�I�II <br /> oo66a69445K4 <br /> Form Approved.OMB No.2050-0039 <br /> Please print or type. 2 Pa e 1 of 3.Em R s ppsse P 4,Manifest Trackin Number <br /> UNIFORM HAZARDOUS 1 Generator ID Number CAL000433477 g l 1 —�+ p-10 00 <br /> 6 6 6944 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 5peedco Truck Lube #338 <br /> SR 99 At Jackstone Exit — <br /> RIPON CA 95366-0000 <br /> Generators Phone: 209-599-7961 <br /> U.S.EPA ID Number T%R000®81205 <br /> 1-rt SAarlel,�.Corffg SYSTEMS INC <br /> 7.TraarsspTo'rtter 2 Company Name LLS.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8,Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPAID Number <br /> 1021 BERRYESSA ROAD <br /> 408-441-0962 SAN JOSE , CA 95133 CAD059494310 <br /> Facility's Phone. <br /> 9b.U.S.00T Description(including Proper Shipping Name,hazard Class,ID Number, rNo. <br /> ners 11.Total 12.Unit 13.Waste Codes <br /> 9a. Type Quantity WLNol. <br /> HM and Packing Group(if any))NON-RCRA HAZARDOUS WASTE, SOLID AM P 223 <br /> (OIL FILTERS) 560 <br /> z 2. <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14 Special Han cling instructions and AddiuonalInformation TSD;SJ 78287960 SP22107 CSS- <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by genera��onferagency authori y <br /> on initial transporter to add or substitute additional trans orters ongenerator's behalf. <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 dassified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If expert shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknovrledgment of Consent. <br /> I certity that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill am a small quantity generator)is true. <br /> Signature Month Day Year <br /> Generatof"Ift ors PdntedlTyped.Name 1 bt <br /> 16.International Shiiljtnants ❑Import to U.S. ❑Export from U.S. �` Port of ermylexii <br /> ZDate leaving U.S.: <br /> Transporter signature(for exports only), <br /> led 17.Transporter Acknowledg me it of Receipt of Materials Day Year <br /> Tra orter 1 Printed/Type time �Siqna `O a Month Day Year <br /> Z Transporter 2 PrinledRyped Name <br /> � .I'c ftp✓ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Residue ❑Pallial Rejection El Full Reledion <br /> ❑Quantity Type <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> It 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> tai Facility's Phone. Month Day Year <br /> W 18c.Signature of Alta mate Facility(or Generator) <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems <br /> W <br /> 4 <br /> a 1. <br /> 20.Designated Faci Own or Operator: ertitl do o ceipt of hazardous matedals covered by the mSgoaturecepl as ed in Item t6a M a <br /> Pri hyped Nam <br /> V , DESIGNATED FACILITY TO EPA's a-M F T SYS M <br /> EPA Form 8700-22i reviouseditl obsolete. <br /> 1)761200311567 7 <br />