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Please print or type.(Form designed for use on elite(12-pitawriter.) • Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST C A D it $ 0 $ >n ? $ $ 0 $00>635.5053 006075596 <br /> JJK <br /> 5.Generators Name and Mailing Address Generators Site Address(If different than mailing address) <br /> E.R. CARPEYMP. r"Yt <br /> 17100 S AARLAN RD <br /> P.O. B(V 279: LATl3T+.OP, CA 9S330 <br /> Generators Phone: s <br /> 6.Transporter 1 Company ame U.S.EPA ID Number <br /> UNIVAR USA IN_'. c� ,A D 0 1 1d 5 2 h 6 7 Ei <br /> 7.Transporter 2 Company Name - U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> C N HARBORS SAN JOSE <br /> 10 I BERRYESSA ROAD <br /> SAIi J<>SEr CA 961 1 <br /> Facili s Phone: C A D O S k d 9 4 3 1. 0 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(If any)) No. Type Quaintly Wtivoi. <br /> 1. NON-RCRA RAZARDOUS KASTS, SOLID <br /> fU9$D OIL FILTERS) <br /> o v M <br /> 4a 181 <br /> z z. <br /> w <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1 . 998007 <br /> PLACARDS PROVIDED BT CARRIFR/IflTP M. YES/NO DRIVER SIGNATURE <br /> **** ER CALLER. MUST TDENTIFY UNTVAR USA AS REG1STRAVr **** <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and IabeleNplacarded,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 <br /> Exporter,I cerfihy,that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)if am a small quanfity generator)is true. <br /> GenemtoesrOge�rintedffyped Name Signature/ Month Day Year <br /> A.. <br /> t / .,. 'w -prt <br /> 16.International Shipmentsv M1 from,U.�. Port of en lext: <br /> F El Import to U.S. El Fxpo tY <br /> Transporter signature(for exports only: Date leaving U.S.: <br /> w 17.Transporter AcknoWedgment of Receipt of Materials <br /> Transporter l PrintedRyped Name _ Signature.' f Month Day Year <br /> V'4 <br /> N � <br /> zz Transponer2Pni y Name Sgriature Month Day Year <br /> rY <br /> r <br /> I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ElQuart' <br /> My Type ❑Residue ❑Partlal Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Ise.Signature of Altemate Facility(or Generator) Month Day Year <br /> zz <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Geitifica6on of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedlryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />