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SK SHIP#., 9w IIIIIIIIIIIIIIIUI ININllllilllll <br /> 71-722,$"070 006657503SKS <br /> Please print or type. A Form Approved,OMB No.2050-0039 <br /> UNIFORM HAIARDOFIS. 1.Generator ID Number CALIW0208133 2.P e o 3.Eme�gpyy Rr sppgse PhgnE 0 Manrfesl Trackinumber <br /> r0066§7803 <br /> WASTE MANIFEST 1 rir910-�6tl 1�b SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Autozone # 5685 Autozone # 5685 <br /> 123 South Front Street 8228 West Ln <br /> MEMPHIS TN 38103 <br /> Generators Phone 209-957-1108 STOCKTON CA 95210-3148 <br /> 6.Tr�n�Sp 9T,Ymffp,'n9r4 SYSTEMS INC U.S.EPAIDNumber `,',XR8g0fa8188J <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322259 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE- , CA 95133 <br /> CAD059494310 <br /> 408-441-0962 <br /> Facility's Phone. <br /> ge 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 WI.Nol. <br /> ' NON RCRA HAZARDOUS WASTE SOLIDS, (SPEN DM P 352 <br /> o T CLAY ABSORBENTS) / <br /> Z 2. <br /> w <br /> (J i <br /> 3 <br /> 4. <br /> 5, <br /> 7475 Handling Instructions and Additional Information TSD:SJ 78578852 AU31470 <br /> 24H EMERGENCY#S00-468-1760—CH/SK/TFI—Contract re ned b�+ generator confers a ncy authori y <br /> on initial transporter to a r 1 tr n o r <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and am classified,packaged, j <br /> marked and labeled/placarded,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 262.27(a)(if I am a large quantity,generator)do III am a smallpRittity generator)is true. <br /> Generator's/Offerors Printedffyped Name Signatur Month Day Year <br /> 2 � + <br /> J 16.International Shipments - + <br /> F Import to U.S. [:1 Export from Pat of entrylexit: t <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspoderAcknowledgmenl of Receipt of Materials <br /> T oder t Printedflyped me Sig Month Day Year <br /> a <br /> 4 Transporter 2 Printe d Name Signature Month Day Year . <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Ll El <br /> Quantity Type F-1 Residue E]Partial Rejection ❑Full Rejegtiorr- <br /> Manifest Reference Number: - <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> f.J <br /> LL Facility's Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Managemen ethod Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) + <br /> 0 1. 2. <br /> 20.Designated Facility C ler or Operator Certification of receipt of cus materiais coveretl the manifest excepta oted in Item 1 <br /> Pnntedfryd Name Signature Month Da Yeap ' <br /> EPI Fgtla87pQ 221R�y12 P evious edit ons are obsolete. DES) NA FA Y TO PA's e-MANIFEST SYSTEM <br /> )/551065 53.3 9 _ � _ <br />