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oJr.- on onxrar Gd IlIDGJf <br /> Please print or type. Form designed for usar n elite(12-pitc :writer.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000406390 2.Pagel of 3.Efoemmr8y edjh �i 4.g .,}(: �°(][2 <br /> Manifest Trackingg�Number <br /> WASTE MANIFEST 'y YY_``_'"`'' �,J `.,i a'w1 SKS <br /> - <br /> 1.5.Gwatofs Neme and Mai yquidrgs3 yt ITir Ge ilift t �Address(ifgiRerenl than mailing address) <br /> 3B6J Duck CreekDrPO Sax 31086 <br /> Stockton CA 95215- i'r56 <br /> General Phone: 916-857-IMO JAN 06 201rj <br /> 6.TrM SYSTEMS, INC. D.S.EPA ID Number TxR®000812`+ <br /> 7.Transporter Company Name - -> - �'�^-�'�^I'-^"U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address LILFHN HRKISUKb tiHN JLIUh LLL U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD __ . . <br /> SAN JOSE , CA 95133 <br /> 418-441-0962 CAL`0,�i949431 0 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1t.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity - Wt.Nol. 13.Waste Codes <br /> 11 <br /> ad <br /> rE— <br /> o 'llSE OIL AtiD ABSORBENT5), N/A , L� <br /> z 2. <br /> UJ <br /> RI,r+CD1VE;D <br /> 3. OCT 13 2015 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information I tiv t .-I is 6 <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> RUTH AS ''AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuse described above by the proper shipping name,and are dassified,packaged, <br /> marked and Iaheledlplacarded,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 cerl that the contents of this consignment conform to the tam of the attached EPAAcknowledgment N Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)lit I am a large quantity generator)or(b)(ifI am a sm quantity generator)is true. <br /> Generator rots Pri ted yip ame Signs tu Month Day Year <br /> P U Ig Is <br /> 16.IntlimShipments <br /> F El Ill to U.S. ❑Export from LLS. Portof en /axil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporterAdmoMedgmem of Receipt of Materials <br /> Transporter 1 PrimedRyped Name Si new re- _ / Month Day Year <br /> aUa ! / <br /> aTransporter 2PnntedRypetl Name Month Day Year <br /> rY <br /> r <br /> I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ ❑ I ❑Full Rejection <br /> ❑Type Residue Partial Rejection <br /> Manifest Reference Number: <br /> 18b,Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> x.) <br /> LL Facilitys Phone: <br /> 18c.Signature of Altemate Facility(or Generator) - Month Day Year <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 �( l/ <br /> 2. 3. 4. <br /> 20,Designated Faclry <br /> iYOmeer or Operator,Certification of receipt of hazamous materials covered by the manifest except as noted in Item Ise <br /> Pri Nei I Si�galer� Month Da Year <br /> EP 81 ousedidonsareobsolete. DESIGNATED FACILITY TO GENERATOR <br />