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J'� <br />-cnvvanmentol Protection Agency <br />f. -OMB No. 2050-0039 (Expires 9-30.99) See Instructions on back of nage 6. Deportment of Tonic Substances Control <br />?type Form designed for use on elite (12-pikh) Fifer.185- O1 Sacramento. California <br />UNIFORM HAZARDOUS <br />nerabls US EPA ID No. Manifest Document N <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />A 0 0 2 9 <br />1 <br />is not required by Federal law. <br />01 <br />3. Gen era toes Name and Mailing Address ADVANCED INTERCONNECt <br />A. State Manifest Document Number 2246016 -.. <br />P.O. 952 <br />22246016 <br />60 6 <br />555 CARNEGIE STREET <br />B. State Gen embr's ID <br />i'1WMome CA 95336 <br />I <br />V <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />Y <br />C. Stale Transporter's ID (Reserved.) <br />SAFETY-KLEEN SYSTEMS, INC Sr 0 5 <br />D. Td sfxs rer's Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. Slate Trans ter'a ID Rese 9 59140 <br />Por I_ <br />F. Transpnrer's Phone <br />9. Designated Facility Nome and Site Addroa 10. US EPA ID Number <br />G. State Faciliy's ID <br />050144 <br />1 Cj"00041401 <br />CLEAN HARBORS SAN JOSE, LL <br />H. Facility's Phone <br />1021 BERRYESSA RD C 9 94 1 <br />11. US DOT Description <br />p (including Proper Shipping Name, Hazard Class, and ID Numbed <br />12. Containers <br />13. Total <br />14. Unl <br />1 <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a. <br />Stele <br />G <br />MERER-9—AiA3 <br />EPA/Otter <br />E <br />i <br />N <br />b' <br />State <br />E <br />NON RCRA HAZARDOUS WASTE, SOLID (WAST <br />EPA/Other <br />R <br />FILTERS) <br />DU <br />P <br />r A <br />WOWF <br />1 T <br />a <br />State <br />0 <br />EPA/Other <br />• R <br />d. <br />Stole <br />i <br />i <br />EPA/Other _.. <br />J. 'Additional Descriptions 6 Materials Listed Above - - - <br />K. Handling Codes Far. Wastes Listed Above <br />6. <br />C. <br />d. <br />15. special Handling Insnucnons and Additional Iniormotion <br />IrIFST R/T4102732818 0002-3386-59 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN TO GENERATOR. <br />SK CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the ronhnts o r co ignmenr are fu y an accuroley described above by propa'r ship�ing name and aro classified, packed, <br />marked, and labeled, and are in all respects in proper condition for frac 0 highway according to international <br />y applicable and nation government regulations. <br />IF I am a large quantity generator, I codify that I have a program in place ro reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyY <br />practicable and that I me selected the practicable method o treatment, storage, or d, <br />'a[ mently available to me which minimizes the present and future threat to human healM <br />and the environment; OR, if I am a small quantity generator, I have made a Failte ofor imine best <br />good mi my wash generation and select the waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Name <br />Signature <br />nth Day Year <br />N17,Tr&qxsftr <br />1 Aclulawledflement of Races f of Materials - <br />A <br />PYrinled/TypadI <br />Na ��' <br />igaalur <br />* Yaor <br />S171 <br />P <br />0 <br />mrv2 Acknowled smart o Relies t of Mahriah ' <br />L <br />Printed/Typed Name <br />Signature <br />MonBt Day Ysor <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />I <br />20. Facility Owner or Operator Certification of rocei t of hazardous materials <br />covered this monifml ex<a t m now in Item 19. <br />T <br />Printed/Typed Name <br />SignatureMundt <br />Day Y7Y <br />DO NOT WRITE BELOW, THIS LINE. <br />PRxeAjRL}q A))0002005250 BJ)0001949020 <br />DTSSU3o /RA)0002117252 H)0002117211 <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />