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Avec &k4 13 - q SSL SK SHIP## -0224127769 Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) EPA Fofin8700-22 Rev. 305] Wtrviouseditionsareobsolete. — kZLESi `NATED FACILITYTO DESTINATION STATE (IF HEOUIHLU) 1) 7 -82`36 f 95(;x_'97 UNIFORM HAZARDOUS 1. Generator ID Number c: r , .. t AL00(3.3� 3�`1 2. Pag -1 of 3 R se 2 i n` i 4. Manifest Tracking Number WASTE MANIFEST 006099834 SKS 6. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) l�!+�y Prrhar-lsor� i:. r'Zt44 S ['a 11'(orn i a St STOCKTON CA 952:06--0000 Generator's Phone: ' Or - 37 :-6` `56 6. TppSoodocl4GomDa wNyne SYSTEMS INC U.S. EPA ID Number Tx R000081 i` 051j 7. Transporter 2 Conn an Name U.S. EPA ID Number CLEAN Hs�R.ORS ENVIRONMENTAL SERVICES INC MAD0693c2'c'S0 8. Designated Faality Name and Site Address CLEAN HARBORS SAN JOSE U.S. EPA ID Number 1021 RERRYE5SA ROAD SAN JOSE , CA 951:i� 4'18-441--0962 CAD059494310 Facilites Phone: 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10.-C ainers 11. Total V. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. o 1 NiIW& NON RCRA HAZARDOUS TASTE SOLIDS, (COOPER AZOLE TREATED LUMBER), 4YLA ` CF �"x P 181 z 2. W 3. 4. 14. Special Handling Instructions and Additional Information 2 WEE5333 p s TSD:SJ 7374554 tJE2.r..r3a C5G: 24 HR EMERGENCY ##1-800-468-1760 (SKI TFI) RUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY 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 classified, packaged, marked and labeledlplacarded, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Year Generato sf Pnnted7Typed N Signalu MINI LL ZQ/ j 16. International Shipments ❑ Import to U.S. Export from U.S. Port of ontrylexit: F- Z Transporter signature (for exports only)Date leaving U.S.: 17. Transporter Acknowledgment of Receipt of Matenals O Tri ort 1 Printed Type Signature Month Day Ye r 1 1 LL �nie Z Transporter Print /Typed are Signature onth Day _ Year F f� rn 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b..Altemate Facility (or Generator) U.S. EPA ID Number J U u- Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z Nazarous hazardous 19. Hazardous Waste Report Management Method Codes (i.e., tales for hardous waste treatment, disposal, and recycling systems) W 1. 2. 3. 4. 20. Designated Facility Owner6r Operator. gertifin of receipt of hazardous gArials eyed by the manifest except as noted in Item 18a Print S g Mo h Day Y I �M /,�� L/� I I isi EPA Fofin8700-22 Rev. 305] Wtrviouseditionsareobsolete. — kZLESi `NATED FACILITYTO DESTINATION STATE (IF HEOUIHLU) 1) 7 -82`36 f 95(;x_'97