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q( <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) RDCR ForrkAp�rwed'.OMB No 2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number2.Page 1 of 3.Emergency Response Phone 17003512479 <br /> anifest Tracking Number <br /> WASTE MANIFEST ' C A D 9 8 0 8 8 4 8 1 1 1 800-535-5053 J J K <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> SILGAN CONTAINER CORP. <br /> 1815 NAVY DRIVE <br /> STOCK'TON, CA 9520.6 <br /> Generators Phone: <br /> 6.Transporter 1 Company me U.S.EPA ID Number <br /> UNIVAR USA INC. C A D 0 1 0 9 2 5 5 7 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Faclity Name and Site Address U.S.EPA ID Number <br /> CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE, CA 95133 C A D 0 5 9 9 9 4 3 1 0 <br /> Facli s Phone: 409-441-099.2 <br /> 9a. 9b.U.S.DOT Description(nclud'ng Proper Shipping Name,Hazard Class,ID"bar, 10.Contalrers 11.Total 12.Unit <br /> HM and Pang Group(K any)) No. Type QuanUty WtNd. 13.Waste Ccd rs <br /> cc 1 NON-RCRA HAZARDOUS WASTE, SOLID, (PLANT DEBRIS) L <br /> O <br /> W <br /> Z 2.NON-RCRA HAZARDOUS WASTE, SOLID, <br /> LLJ <br /> (OIL FILTERS) ( D M y yo <br /> � <br /> 1 223 <br /> 0Iv <br /> I _ AI'- aAOU Wl4i E� -SbL(, <br /> fEHP �a�,hsS DF I D {� <br /> s12 <br /> 4. <br /> 14.Special Handing Instructions and Additional Information <br /> 1. 386878 2. CH3041190 3. c1-13oyge3 <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIGNATURE _ <br /> **** ER CALLER MUST IDENTIFY UTIVAR USA AS REGIS'T'RANT **** <br /> 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,pecf aged, <br /> marked and labeled/placarded,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 cetify that the contents of this consignment conform to the terms of rhe attached EPAAcknowledgment of Consent. <br /> I certify that Ih to rnirdm¢ation statement Identified in 40 CFR 262.27(a)(R I am a large quantity generator)or(b)(III small quantity generator)is We. <br /> G to emus PhrrledM&-� <br /> Si Month Day Year <br /> � /r <br /> J 16.Interntional Shipments <br /> Z ❑import to U.S. ❑Expert from U.S. Port of entry/ex'd: <br /> Transporter signature(for exports only). Date leaving U.S.: <br /> M13: 17.TransporterAckrwwledgmenl of Receipt of Materials <br /> ac T 0 N,ter it K-L/o Name 0� S' afar 0 Daq IIIy Year <br /> a Ca\XA <br /> Transporter2PnntedilypedName S' nature Month Day Year <br /> t- <br /> 18.Discrepancy <br /> I Be Discrepancy Indication Space' <br /> Quantity ❑Type ❑Residue ❑Partial RejeGbn ❑Full Rejection <br /> Manilost Reference Number. <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> 7 <br /> U <br /> r¢+ Facility's Phone: <br /> LCL] 18c.Signature o(Alternlale Facility(or Generator) Month Dar Year <br /> z <br /> F� 19.Hazardous Waste Report Management Meti Codas i.e.,cafes for hazardous waste treatment,disposal,rn eP nage� ( poral,and recycling systems) <br /> Q 1. 2. 3. 4. <br /> 7,0,Designated Facility Owner or Operator.Certification of recoQt of hazarcous materials covered by the manifest except as noted In Rem 18a <br /> Printedffyped Name Signature Month Day Year <br /> EPA Form 8700 22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 9001E SMVS }INVIINBAI2t f NOIN30.LS NV9'IIS T926 996 60Z YVA 6Z:gT 800Z/TT/60 <br />