Laserfiche WebLink
SSL SK SHIP# 222360776 111111111111111111111111111111 <br />0056454548 K8 <br />Please pant or type. (Form designed for use on elite (12 -pitch) typewriter.) ForntApprnvnd. OMB No. 20540039 <br />cru ruu oew-<c lrtev. avol rrevuus emraxusare oosoece. DE51UNA1 ED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />1)7582967/958297 ., n 3)7583006/958364 <br />r `tai <br />UNIFORM HAZARDOUS <br />1. Ger—br ID Number <br />CAL000393929 <br />2. Page 1 of <br />1 <br />3. Farea Resparso Phare <br />1-�0 -468-1760 <br />4. Manifeat Tracking Number <br />005895454 SKS <br />WASTE MANIFEST <br />5. Generators Name and Mailing Address Generators Silo Address (d different than mailing address) <br />Weyerrhauser <br />2700 S California St- <br />STOCKTON CA 95206-0000 <br />Generators Phone: 209-373-8256 <br />6. T r 1 Can an Name US EPA 10 Nnmbor <br />�ETY-�(L0EN SYSTEMS INC <br />TXROOOOS1205 <br />7.1ra sporthr 2 Company Name U.S. EPA 1) Number <br />8. Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S. EPA ID Number <br />1021 BERRYESSA ROAD <br />SRN JOSE , CA 95133 <br />408-441-0962 CAD059494310 <br />Factil es Phone: <br />9. <br />91b. U S. DOT Description (nckudng Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers11. <br />Taal <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Parking Croup (if any)) <br />Quantity <br />M./vol. <br />or <br />' NON RCRA HAZARDOUS WASTE SOLIDS, <br />� (COPPER RZOLE TREATED LUMBER), 4LI& <br />DM <br />300 <br />P <br />iBl <br />w_ <br />i <br />w <br />- <br />;------ — — <br />— <br />DM <br />35 <br />c� <br />NBNE� NON RCRA HAZARDOUS WASTE SOLIDS, <br />(AB5 RBENT AND 071) <br />- <br />DM <br />P <br />352 <br />4. <br />14. Special Handing lnshuctias and Addidonai Inroonmeon TSD : SJ 73669842 WE25333 CSG: <br />b 1�& <br />3 <br />24 HAUTHR EMERGENCY #1-800-468-1760 (SK/ TFI) <br />"AGENT-FnR" BY GEN Tn RETAIN <br />LTCFNSFD SIR CARRIERS AS WrFSSARY <br />15. OENERATOR'S10FFEROWS CERTIFICATION: I hereby declare that the contents of this casigrwmwd am luly, and acaaakiy described above by the proper shipping name, and are classified, padraged, <br />marked wid labalediplacartbd, and are in all respects in proper common for transport according to applicable international and national governmental regulations. H effort shipmeri and I am the Primary <br />Exports, I oetfy Stat the contents of this mWgnment mrllorrn to the terms of the attached EPAArksoMedgment of Cemorl. <br />that the sbtement derided In 448 CFR 26227(a) (il I am a large quantity generator) a (b) (HIm aa emal quantity generator) is true. <br />a�Iac�errrttify wwasstt-e�m�iynniiimizabon <br />v Gly lH 'iJ 2L4 /L� ped NameSIA /1 Mogi Day Near <br />C!./J 5 2 <br />16. Inlenetionel Shiprtpn5 <br />❑ Import b U.S. ❑ Expod from U.S. Port of etrylnudt: — -- <br />Transporlex skrebtm (ter exporti Dam leavcg U.S.. <br />W17. <br />TransporterArknowledgmerd of Receipt of Materials <br />o <br />T 1 PrinledR me Signabu <br />N <br />i <br />Q <br />Tran Name %nabx Month Day Year <br />H <br />18. Disneparlcy <br />1 <br />18a. Discrepancy Indlralbn Space ❑ Quant ty ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number <br />J <br />18b. Attemate Fadlity (o Generator) U.S. EPA ID Number <br />U <br />LL <br />Faditys Phone. <br />W <br />18c. Signature cf A bemete Facility (or Generator) <br />Month Day Year <br />Q <br />z <br />N19. <br />Hazardous Waste Report Management Method Codes (Ia.. codes for hazardous waste treatment, disposal, and rerychng systems) <br />w0 <br />1. 17LN I <br />2. wj Ll <br />3. <br />1. <br />20 Des 9nakd FaalAy Owner or Operator Certification of rear pl o(hazardan materials covered by are manifest exwl as noted b Item 18a <br />1 <br />Pnnt.drryped Name Sgnabae Month Day Year <br />cru ruu oew-<c lrtev. avol rrevuus emraxusare oosoece. DE51UNA1 ED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />1)7582967/958297 ., n 3)7583006/958364 <br />r `tai <br />