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Sep 14 2015 10:47AM HP FaxLadds Marina 2094779585 page 5
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<br />rorm Approved. ON18 No. 2050-0039
<br />(JNp i. Cerlemilor ID Number.. �; 1 Of 3'. Emergency Response Phone 4. Man t Tracking umber
<br />WAST MANIFESTieil�rr+
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<br />5. Gtlnerat es'Name and Mailing Address e; t :t herator's Site Address (6 different then rrailing address)
<br />I -adds Marina patrici4 Bonnffit-1
<br />491.1 Biu l@'%VY Cove Way
<br />Stockton CA 95219`-20 GEIVEL
<br />Oenarator'sPhone :?fj-•x,77-L�
<br />6. Transported Gnmpany Name U.S. EPA!D Numder
<br />SA1kIETY—KL SYS -TEAS, JNCC
<br />SEP 14 201 rx �
<br />Transpoder 2 Company Name
<br />.iP U.S. EPA ID Mrmber
<br />slgr ecdi-Y Name aridSite MBiess _ ..__ _ .. tTlJiICDARYt1AE=y11Ti1.6.EP�(IDWtlt11b�9'''
<br />�Gt.. 41 HARIBOR S BAN JOSE L ,moo _.�
<br />I&N BE RRYESSA ROAD
<br />SON JOSE CA 95,133
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<br />Fadily's Phone c0m"75194943.10
<br />98,
<br />9b. U.S. DOT Deecripion (including Proper Shipping Nome, Hazard Class, ID Numbar,
<br />10. Containers
<br />t 1. Toter
<br />12 Unk
<br />HM
<br />and PeLia»g Group (zany))
<br />Quantity
<br />Wt.IVel.
<br />13. Waste Cedes
<br />Na.
<br />Type
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<br />' ; 7 FifiZlal�l7t WASTF SOLID, N. t7,. S.
<br />(C lAhimium, LCA), 91 111
<br />DK
<br />690. W
<br />Dft".),
<br />D008 181
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<br />A1ViKD 1 I�
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<br />3 7 HAZARDOUS WASTE, SOLID, N. 13. S.
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<br />pedal Handling instructions and AddltcnalInformation l 57669484 #A28534
<br />e4 HR EKIERReCy i1gie-468--1 10
<br />(SAFETY—KLEF.N')
<br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of Itis conslgnmerd are fully and socbralely described above by the proper shoing name, and are dassiAed, packaged,
<br />marked and Iabeledliplararded, and are in all respects in Draper condition b! transpart a,dording to applicable inlerr'a6onaiand national governmental regulatons. If export shgment end Ian the Primary
<br />Expo ler, I:cerfify that tho contents or this consignment conform to the terms of the adtached EP.4Admowfedgmard of Consent, d
<br />I certify fliat the waste minimization statement identified m 40 CFR 262.27(8) (i I am a large quantify ger evatc r) Dr (b) (if 1 am a sum.1 quantity generator) Istrue.
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<br />❑ Impon to U.S. ❑Export from U.S. Port of entryleit
<br />TInsporfer signature (for exports only): —"
<br />Date leaving U.S.:
<br />17. TranWrterAcknoMedgment of Receipt of Materials
<br />Trans l PriitedRyp me Signatu Month ay Year
<br />LOOP
<br />Transporter 2Prntedrrype arae
<br />5igra4xe MonttDay Year
<br />18a Oiscreosncy indication Space
<br />❑ QUanUty ❑ Typo ❑ Residue ❑ Partial Rejection ❑ Full ReJOulbjl
<br />Ma Acct Re Bence Numoer
<br />1Rr. Allemete "ecititp ;or Generator)
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<br />U.E. EPA ID Number
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<br />FaciiilyS Phono:
<br />18C :Signature PalarnateFacility (or Gerlerstor)
<br />Mont Day Yew
<br />10. Hgzardaus Msia Report Management Method Codes (i.e., codes for hezardcua waste treatment, dfsppsel, and. recycling systems)
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<br />20. Designated Facility Owner or Operator. Cattificatier, of recolpl of hazardous rnafartats covered by Ire maniW woept as riled in Marry 188
<br />pMedlTjped Name J r r
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