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SK SHIP#,, 226655807 <br /> ,�. ... <br /> Please print or type. <br /> -0NWORM HAZARDOUS 1.Generator ID Number <br /> WASTE MANIFEST arde <br /> AL000352832 2.Page11 of 3. m9�py lip: Form Approved.OMB No.2050-00: <br /> 5.Ge erators Name anti Mailin Address Q�R t3] 4.Manifest Tracking Number <br /> 2577 Wr Trucking/Classic Sales IR,` Generators Slte Atldres3{i(diRe ant than ma tlingOatldOe�776181 ��� <br /> 2577 W Yoseoite Ave F <br /> MANI'ECA <br /> Generators Phone 209-249-3288 CA 95337-%41 <br /> � <br /> 5,T <br /> SYSTENS INC <br /> 7.Transporter 2 Ccm an Name U.S.EPA ID Number <br /> CLEAN H9I1HL1R5 ENVIR TXR000®81205 <br /> OWNTAL SVC INC, us.EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> CLEANHARBORS SAN JDSE INAD0393250 <br /> 22A <br /> 1021 SERRYESSA ROAD Us EPA ID Number <br /> 408-441-0962 S JOSE <br /> Fatality's Phone: CA 95133 <br /> 9a: 96.U.S.Dg Group <br /> (including Proper Shipping Name,Hazard Class,ID Number, CAD059494310 <br /> HM and Packing Group if ion(i <br /> —�� 10.Containers <br /> 11.Total 12.Unit <br /> 0 � � _ 2ARDOUS WASTE, SOLID No, Type Quantity WI13,Waste Codes <br /> RS)W <br /> DM P 223 <br /> 3. <br /> 4, <br /> 74_Special Handling Instructions and Adtlitional Infonnalion TSD➢5,J 779693 <br /> ' 1-6 SA15065 <br /> 24H ENE CSG: <br /> on RCY#,800-468-1760-C _ j�' t <br /> initial trans orter to add/�/TFI Contract retained f ,y ��lyy <br /> 15. GENERATOR'S/OF or substi by generato <br /> FEROR'S CERTIFICATION: (hereby deGare that the contents of thistcentg madrCltlltz Onaately described above by the properCppinge me,ab are classified,markedandlabelthat tt cardetl,and are in all respects inpmper contlition Fortmnspon according to applicable intemationaland natioa 90e Qete g5 hoOnlf expenera en behalf.autharY <br /> P s behalf. <br /> Exporter, certify That the contents of this consignment conform to the terms of the attached EPAgcknowkdgment of Consent. <br /> certify that the waste minimization statement idenfified in 40 CFR 262.27(a)(if amalera quantity the Packaged, <br /> Primary <br /> eror's ri ed/fype Name 9 g ty generator or if I am a s II uanti <br /> O( 9 N gen raNr)is(rue. <br /> Sgnature <br /> � 16 Intemafional Ship Month Day Year <br /> ~ ❑Impart t°U.S to <br /> ? TrapsPorter signature(for exports only); ❑Export from U.S. <br /> w 17.TransporterAcknowladgment of Receipt of Matenals Port ofe /exit: <br /> F.; Date la Ing U.S.' <br /> Oer 1 PrinteMyped ame <br /> n nature <br /> 2a 2nsporter 2 Prints Month <br /> 1' ed Name Day Year <br /> F— , Signature 1 ,01 <br />( j18.Discrepancy ����--3/ Ir f Day your <br /> 18a.Discrepancy Indication Space <br /> I ❑ Quantity <br /> �Type ❑Residue <br /> ❑Partial Rejection <br /> ❑Full Rejection <br /> 18b.Alternate Facility(or Generator) `rt-Manifest Reference Number <br /> fj <br /> LL Facility's Phone: p <br /> U.S.EPA ID Number 7 <br /> W 18c.Signature If Alternate Facility(or Generator) <br /> Q <br /> 2 <br /> y19.Hazardous Waste Report Management McNdd Codes(i.e,codes for hazallous waste treatment;iljs Month Day Year <br /> W 1 <br /> 2. Poral,end recycling systems) <br /> Y 3 <br /> 4 <br /> Printed/Typed Name . <br /> 20.Designated Fa lily er .or Operator. emfcahon f ceipt of hazardous vered materials coby the manifest ex pl as n din Item i8a <br /> E gpp,��fF2 J ' Signatur <br /> ob et <br /> EP9 Jwii17Ctl173��'. J M y <br /> 1 evious di s . f <br /> DESIGNATED FACILIT TO GENERATOR <br />