Laserfiche WebLink
Slate of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-991 `4.1 <br />Negro print or type. Form designed Far use an elih 112 -pitch! lypewrihr. <br />0 <br />H <br />n <br />h <br />m <br />CO <br />nm <br />v* Q <br />v* U <br />r2 <br />eftesC <br />V� <br />VU <br />Z <br />Y <br />1- <br />C <br />Q <br />U <br />See Instructions on back 0,18e 6. Department of Toxic Substances Control <br />Cr`sg09A7. Sacrament, California <br />a DO NOT WRITE BELOW THIS`LINE.: <br />EPA0700-24"` <br />Yellow GENERATOR RETAINS <br />UNIFORM HAZARDOUS <br />Generato/s US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST <br />14 s y y S <br />I of 1 <br />r, <br />3. Generator's Name and Mailing Address <br />Advanced Interconnect 564 Can agle Street <br />A. State Manifest Document Number 2'�?!# n A5'4:49 <br />S64 Camst Street Manteca . CA 95,3°M <br />- - <br />B. State Gen.,w is ID <br />M3nwa, CA 95336 ., <br />A. Generator's Phone I I <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transport.i s ID [Reserved.) - <br />Clean Harbors Env Servioes Inc h .1 Q 9 1 9 21 21 215113 <br />D. Tr ..... rter s Phone (781) 849-188 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID Reserved.] - <br />I I I I I I I I I j <br />F. Transporter's Phone ; <br />9. Desi nated Facili Noe and Site Address 10. US EPA ID Number <br />Cleanel iarbors xSman Jose LLC <br />G. St.% Facility's ID <br />1021 Bertyessa Road <br />H. Faciliys Phan. <br />San Jose. CA, 95133 - 4 11 41111113 <br />(406) 451-5000 <br />11. US DOT Description (includingProper Shipping Name, Hazard Class, and 10 Number <br />P p° PPh 8 I <br />12. Containers <br />13. Total <br />Quantity <br />Id. Unit <br />Wt/Val <br />L Waste Number <br />No. <br />T <br />a.NUN RF.;RASOLID((F=MT r A 1 )) <br />'talo <br />Y <br />G <br />G U i <br />F <br />o 0 0 0 1 <br />E"A/f�h1a . <br />Nb. <br />State <br />E <br />R <br />EPA/OtherA <br />T <br />C. <br />Stile <br />R <br />EPA/Other <br />d. <br />State <br />-EPA/Other <br />J: Add�ijonal Descn tigas For Materials Listed Above <br />118.'Ji 11f Cg r <br />N. Handling Codes Far Wastes <br />Listed Above - <br />a. <br />b. <br />d - <br />S I Handli ru ons nd A 'tional Inform tiHOURMERGE I }! <br />��7eib'�jf To <br />rr roper F w{ienRan Ing waste 9 �a. CH52399 ` <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuraMy described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respe,ch in proper condition For transport by highway according to applicable international and national government regulations. <br />IF I am a large quantity.generahg (certify that I have a pro ram in place to reduce the vol me and toxicity of waste generated to the degree I have determined to be economicdlly <br />practicable and that I ave selected the practicable method of traotment, storage, or dispo currently available ro me which minimizes the present and Future throat to human heahh <br />and the environment; OR, if I am a small quantity generator, I have made a good faith h minimize my waste generation and select the best waste management method that is <br />available to me and that can aFFord. _ <br />aG�y <br />'ignatar. �i.�: <br />�6°°�1 I Do <br />'7 <br />T <br />17. Transporter I Acknowledgement of Receipt of Materials <br />APrinted/Typd <br />Name <br />'nWJI'Ec <br />ign ter <br />�. <br />* D <br />r °� °� <br />_ <br />E . t_OUA7(1 <br />r <br />r <br />t <br />18. Tramspourter 2 Acknowledgement of Receipt of Materials ' <br />RPrhred/Typed <br />T <br />Name <br />Signabrs <br />Month Day ', Year <br />E <br />R <br />19. Discrepancy Indication Space - <br />F <br />A <br />c <br />L <br />I <br />20. Facili Owner or Operator Certification of receipt of hazardous materials covered b tem this manifest exca t as noted in I 19. <br />TPrinhd/Typed <br />Name <br />Sigbahro - <br />Month Day Year <br />Y <br />- <br />- •. <br />a DO NOT WRITE BELOW THIS`LINE.: <br />EPA0700-24"` <br />Yellow GENERATOR RETAINS <br />