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• <br />> Jul -21-2004 01:58am From- <br />�V <br />• <br />T-252 P.004/009 F-348 <br />-161"T" <br />7o-1 <br />5M. of Cvlifarnly—Eminnmmml Profvdien 3o <br />,� .- .` , — Q 1. $" Instructions an DOCK Oi Saeromenb, 6 Ilfmrmia <br />Infomrml,.1 In dr. orw> , <br />I Approved 00 No. 2050-c,d ,[W <br />Pmm, d . , for we on dile F17pikh) D'P•"'rIM' <br />a �n1�4 �e <br />FelLfia <br />y Paye 1 <br />1 b nal reaulred 6y Federal lar. <br />'ll P.,1 or ry <br />HAXARD U5 <br />1. Gmlalafl u5 EPA 10 <br />UNIFORM <br />WASTE•AIANIFEST <br />_I <br />A, j, <br />and Wlliny Addnw <br />iRPI j%kl <br />I.A. \.1� °, f�4. �z. ,\ <br />9. Gw.reaY>Nerve <br />1 <br />1333 <br />n ° ` <br />t., c`�, <br />C) 214119 <br />4, d. Qiwrawl1 Pham. <br />US EPA ID Numleer <br />M �\, VS r <br />N 6. <br />n <br />r s. iran.pemri CanpmY Nome TXROUGUS09311 <br />SYSTEMS <br />r r <br />iTi. ;•?n�\\ )�� '�^� b. <br />m SAFETY-14LEEN <br />1 <br />t <br />V. Onipnat.d Fecillly Naw and Sb. AdIII D'r 01 § 4 , �. •••• •• - .... <br />CLEAN HARBORS SAN J08E, LL CADO59494310 <br />1021 BERRXESSA RDA 8 133 <br />AN JOSE <br />1JX <br />1. US DIN DOWI llan I" dl Paps Shipping Nmee, Hal Clare. and to Number) <br />z NON-RCRA HAZARDOUS WASTE LIQUID <br />' OIt,4r1ATER.SLUD�EINOT DOT REGULATED) <br />G <br />E <br />w E <br />-4 R <br />Itan, A <br />S 0 <br />R <br />ad Addiliowllnfa,naatfvn MF ST R/T <br />A00-•468-1760(24HR):. IF UNDELI <br />TIED TO RETA114 LICENSER iJBSEQi <br />SKDOT# A: 3757 B. <br />N: Ih.r -.clow lhelrheeml.na of lhfammlgnmeni.. Noy and P tr, dercri6ed al bl'ad wd 1pp ny mvme Ong ave mv..inw.pw«. <br />* In vll wrpem in prop.. enndlrian (Or ryvmpe•l M hldh"'O1' ^�°rdina b ,PP amble l^I.rvalh^el.ml rlm�mnm+ ye..rnmenl r.0ulalb^.. <br />clq aF, m F.ml ed b the deyrm I I J,N.ined b b. mamOmlcell <br />mlial" am. rhleh mfnimli,,dm I and <br />� in.?N hhumn -1I� <br />my .mm yrnermien and wIW Ike 6m O•'^ al <br />TT <br />ABLE <br />ARRSERaHIN A1NEC <br />SE <br />C: L: <br />I mrll(yPa.b red. the —I.- and Ia,l <br />If 1 an a lerp. muenitp 1.1 -de minable <br />dlml I aw a wm in <br />pwcllcvble vnd thm I , If Joni 0 It. <br />wvyen.wbr, I hm+mee4 Inwhado y fmith i wNal�° min mra <br />and Ih. •m+renP.vr: OR, D' <br />al b me and that I mn GEerd. <br />DTIC 9022A (IM <br />EPA UYCO-22 <br />Year <br />iiynvluw rR � S�•, ^ <br />p <br />DO NOT WRITE BEI THIS LINE. L+ <br />White. TSDF SENDS THIS GQPY TO D}56 9Wf1Hf2 $0 DAYS. <br />TO: P.O. SOX 3DOO, SvcremeTtlo, <br />