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c <br />C <br />c <br />c <br />C <br />C <br />0 <br />U <br />L <br />U <br />L <br />U <br />v <br />L <br />C <br />V <br />LL <br />L <br />C <br />a <br />2 <br />LL <br />r <br />4 <br />L <br />VA <br />Approved OMB No. 2050-0034 if <br />print or type. form designed for <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUS <br />Generator's US EPA ID No tiM�nifest DoeumeriF ? ?yrlPo$d Tr .$ormatiun� �1da atq_ <br />WASTE MANIFEST <br />G L00022104' aq.. �F etaltaw > <br />3. Generator's Name and Mailing Address IN TERMINAL SVC <br />540 S AUSTIN <br />A state Manifest Document Number r� <br />SAVE GARL.00K <br />n <br />:a ���•{`�'(?�( CA cJ 21 r <br />B. State Generator's ID <br />n <br />4. Generator's Phone 0 9] 4 6 0 _ G C Z <br />` <br />V <br />n <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />b <br />: AFET'A-Y.LEEN SYSTEMS INC. C O 0^51 O <br />D• Transporter'sPhone <br />o <br />_ <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Q- <br />E. State Transporter's ID [Reserved.] <br />J <br />1 <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />i <br />� 0 C7 � � <br />,f'L'T'L'—KLE.EN ((SAFi JOSE) I <br />H. Facility's Phone <br />j <br />021 BERRYESSA RD CA 0594043 (� <br />- <br />SAN 'TOSS CA 95133 <br />408 285-6441 <br />1 <br />11. US DOT Description (includingProper Shipping Name, Hazard Class, and ID Number <br />P p PP g ) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />= <br />a. <br />N014 -RCCA HAZARDOUS WASTE LIQUID <br />stare <br />-'222 <br />G <br />OIL, MATER, ✓LUDGE(MOT DOT REGULATED) <br />>�.� <br />T <br />)0'�. <br />EPA/other <br />E <br />i <br />N <br />b. <br />state <br />i E <br />R <br />EPA/Other <br />A <br />> T <br />C. <br />state <br />i O <br />R <br />EPA/Other <br />i <br />d. <br />State <br />i <br />i <br />i <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />cl. b <br />14 <br />/� i ALJ J31 <br />15. Special Handling Instructions and Additional Information <br />MF'ST R/T 02107923 0002-6933--98 <br />11ERGEN,CY R—S300-468-1760( 24 HR), IF UNDELIRABLE RETURN TO GE!gERATOR. <br />.)K CORP [AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECE-SARY. <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and -are classified, packed, <br />marked, labeled, <br />and and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the and future threat to human health <br />present <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Natrrar' J -� <br />Signature ! <br />nth Da Year <br />T; � <br />T <br />R.... <br />... ...... <br />17. Transporter I Acknowledgement of Recei tof Materials ,,"••�'�� <br />A <br />Printed/Typed Name _ - _ rj� <br />Signatur ,. /" <br />F �� r .. ./� <br />Mon f ci Year <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />RPrinted/T <br />T <br />YP ed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />L <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manif st,oseee t as noted in Item 19., <br />T <br />Y - - <br />PrintedLTyped Name — `- <br />-- �� �; •:1-r, /� ,-:1-r' /r� -�� ��''=-C <br />t� <br />Si na <br />Signature <br />v`� � f�:�..,t.,:'.r-_-.._ „ <br />Month Day Year <br />� <br />L' �� % �0 1 �,L�{ <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />