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0 <br /> Pease print or type.(Form desgned for use on efde(72-pAch) f.)61 1702984126-002 SC PPW 5/30/2017 Forrr Approved.OMB No.20$0-0039 <br /> UNIFORM HAZARDOUS 1.Generali t0 Numbtt 2.Page t d 3.EmaNen�Rasparse Phone a.Man t racJp^g N�blLr <br /> WASTE MANIFEST CAD 9 8 3 6 0 0 5 9 4 1 800 4833718 U 8 7 F�,� <br /> 5.Genese f Uame elle Malgng pgGreu Gere s ee Maness(a OAlena l tmn Mi ina am ) <br /> 11Stock West lane 7373 West LaneO109W <br /> Stockton.CA 95268 Stntimoo.CA 95210 <br /> GenenNya Prete: (2091476-5966 ATIII:)essif7a Cavan <br /> PtlMpofel anparty ama <br /> U.S.EPA ID Number <br /> Clean Harbors E+Ivwanner dI Services.lna MAD 0 3_9322250 <br /> 7.T2nsporttt 1 Connpam/Name U.S.EPA ID Number <br /> B.Desgnaled Faddy Nana and bal U.S.EPA ID Nunber <br /> Clean Harbors San Jose LLC <br /> 1021 Bemressa Road C A 0 0 5 9 4 9 4 3 10 <br /> Sanlose.CA 95133 <br /> Faobtys Rnrle: <br /> 9a. 91,.U S.DOT Dcs pfion(Mdul^g Pm,Snipping Nome,HMt CM .fD NumMr, 10.Cmleine <br /> HM am Pa lm Cnoap(AanYl) 11.ipol 12.Urv1 <br /> Yc. Type GLantily 'MiW U.WaSle Codas <br /> g UN1950.WASTE AEROSOLS,FLAMNIABLE,(MR HOT D001 551 <br /> X EXCEEDING i L CAPACITY),21 0 01 D F 0 0 0 0 P <br /> w <br /> z <br /> 0 UN1950.AEROSOLS.NON-FLAMMABLE,(EACH NOT 551 <br /> X EXCEEDING i L CAPACIM.2-2 001 D F 0 0 0 0 p <br /> 3. UN3028.BATTERIES,DRT.CONTAJNING POTASSIUM 181 <br /> x HYDROXIDE SOLID.8 00i DF 00012 P <br /> NON4KM HAZARDOUS WASTE.SOLIDS'OIL FILTER) 001 D F 00008 p �2 <br /> la Speed Hanlrcg a44bLCEMSaM PM x i rnfp:marian <br /> 1.LCCRQ E W4126 1X10 FLEETM5647 <br /> 2.LCCRQ E3=2126 1705 <br /> 3-CH843809455115 <br /> ERG#154 1X5 <br /> 16. OENERATIMWFF ROR'SCER"'CATON: IhmbydeduetlWb¢cgwbofarsemygsn mnmryg amrj"desobaaebovebyfieryogr#.Wngnw.ad"AaSNMy "Ia* <br /> rtarkea and IebnledlndaratGa,and ere N all map"in pmptt aandn d aalsyarl aom"M bappliMW inNnuaiaSd xk MWII 9(W0nMIIrWre9liaEas M <br /> F3pMtt,lceMy Mal Ne COnknls dtAB AdxvaSNgmenrdCansert eapalshplenlaM lam tlae Pomery <br /> lAllalglllll611t wnMrnl m ae tress ape etbllea EPA <br /> ISa+61y OW Ile wade mnalMM$WlMenl 16WUW 040 CFR 26227(a)(4I am a b19e gmtrty gayraw)or(b)(a I am a sma Na^My 9eneralx)fs bee. <br /> GenwainPrOffel Porial Narne <br /> n eer <br /> 16.Intsmemaarl'�oaeMs ff061 20 <br /> 2 L�mpadM U.S. ❑Ermorl horn U.S. atdengleall_.. <br /> Trzns ve baa o -- --- <br /> 17.Trd MMWAdwAedgnentdRNxptd Malauls laal,4V <br /> ratt PImRl7ype[Name <br /> p, wnaj�� /J ay Yur <br /> Transporler2 Prn4W ype<Mr. nature <br /> ear <br /> 1IB.DLsn a my <br /> 1BaDlsnepamyIWlcvoSpae ❑ CuaMily ❑Type ❑Rescue ❑PrawRaBcoon ❑Fug Rejection <br /> I BO.AIMmare Haddy(m Genenmr) Mana¢slBderena Number <br /> � U.S.EPAID NIAIIbB( <br /> U <br /> LL Fad' s Phme: <br /> W 1tk.6ignaluedNMmale Fea7dy(a Gennala) <br /> Mone Day Yeas <br /> 2 <br /> W19.1bmdouS Wash Repod Mar%emeM Meded Codes(.a..COGS for haralaous nese baabnant d,Mg.and IAcy'rAIR syeSems) <br /> H141 2 a. <br /> H341 Ni41 H1.41 <br /> 20.Design end F D,Sn^r a Opelafor Cetifl®Oon d d MaMouS YaafeGy bY'Ne rtaMeal roMd in pem 16a <br /> 11 Pr�Iear7ypad <br /> 59^aW Day Yea, <br /> NV In <br /> EPq Fodn 8700.22(Hev 3-05) prenouseoraons reahsole D NATE ACILfTY DESTINATION STATE(IF REOUIREO) <br /> Clean Harbors has the aprrgriau permits for and w81 aae't the waste the w 6 Sit <br />