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.. ...... ..... <br /> SSL SK SHIP# 229804897 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page of 4.Manifest Tracking Number <br /> WASTE MANIFEST CALM393245 1!e9&! P1'60 <br /> 007313307 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> O'Reilly N 3477 11 1 <br /> LODIW Lodi. Ave CA <br /> '3240-3423 <br /> Generators Phone 209-369-1988 <br /> 6.Tre9TY1WE9M SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MMM9322250 <br /> 8.Designated Facility Name and Site Address CLEAR HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> 408-441-0962 SAN JOSE , CA 95133 CAD059494310 <br /> Fadlity'a Phone: <br /> 9a. 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 WtNol. <br /> 1. -NOW. NON-RCRA HAZARDOUS WASTE, SMID, DM T P 181 <br /> 0 lit-NOW. <br /> AND OIL), N;%A <br /> z 2. <br /> w <br /> f7 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSDaSJ B146U36 OR14435 pCSSS.- <br /> 24H EMERt3ENCY#800-468-1760-CH/SK/TFI-Contract retained by jive J 2tor Eonf € y authori y <br /> on initial transporter to add or substitute additional trAss behalf, <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fuly and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper omdiUop for transport according to applicable international and national governmental"dilation.If export shipment and I am the Primary <br /> Exporter,I certify that the contents M this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I ready that the waste minim" "on statenV4 GFR 262.27(a)(t I am a large quantity generator)or(b)(t I am a small quantityge mtar)is true. <br /> GeneretorslOffemrs PdnteOlTy Name Signature Month Day Year <br /> 16.InlittuafignablWindierts ❑ - <br /> import ❑Exportfrord'u.s. Port of entrylexil: <br /> Transporter signature(for exports only)5., Date leaving U.S.: <br /> LJ <br /> 17.Transporter Acknowledgment of Rece'rytofMaterials <br /> Tran r 1 Print Name Sigma Month Day Year <br /> 0 e� O <br /> a C, T <br /> z Transporter nted/Typed Name Signature in Day Year - <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 11,11 ❑Full Rejected - <br /> Manifest Reference Number: <br /> 181h.Alternate Facility(or Generator) U.S.EPA ID Number <br /> -3 <br /> LL Facility's Phone: <br /> W 18c.Signature atAltemate Facility(or Generebr) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> O 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator Cer fication of receipt of Hazardous materials covered by the manifest ex t as noted in Item 18a <br /> PnnVLLyKo Name Sgnature Month Day Year <br /> r <br /> EPA Form 8700-22ttRTev.12-17 Previous editions are obsolete. DESIGN D CILITY TO GENERATO <br /> 12-17 Previous <br />