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Jun 16 03 10:43a P.5 <br />See Instructions on bactcof b. DapmtmentofToxicSubstancesControt <br />State of CaYbmio-Em+ironmento; Protection A®ency Socromal!e, Coliforn a <br />Form Approved OMS No. 2050--0039 lExpiras 9.30.99) - 2, ,age 1 information {n the shaded areas <br />" Pteasa pri-,i or type. Form aaaignod For use on afire f i Z•F•iYh} typewriter. ��" Manifest Document No. g <br />-'-`— 1. Generator's US EPA-!tt°�e• i is not required by Federal low. <br />UNIFORM HAZARDOUS �,yj. O }Q 1 <br />WASTE MANIFEST , I I I s -- — — <br />a. State Manifest Document N,'mber rLJ -y ®8 4 3 „t.'+. ® 9 <br />3. Garold"' <br />�! �W%e '7l i6 g. Two Ganoro!or'x VD <br />-�; 1 <br />N A. Generators Phone (2m I C. StcM Tronsporiar's ID <br />US EPA ID Number _ <br />C-43. CroespoAer I Company Noma 0, Tronsparte% s Phan_ (600) 972-5294 <br />m EVER'3REEN EWIRONMENTAL SERVICES IC L� I�. 9 g 2 g 3 2 5 12 8. US EPA E. State Tronspodeetarve <br />r's ID (Rd.1 <br />7 1 porter 2 Campony Nnme ., <br />+ �'j�/ ^�� C p^ .y.�P ' i f F. Transportar'a Pt+a^a <br />QI I �• r tl �1 C.i� sit(,' cFA I6./ Vi G. Sy Iotafac'iity'a ID <br />V q, Dae aced ocil,ty Name and Site Addrosa 10. US cPA {D Number C j A i D 1 1 ,5y, 9 <br />-4 d) SAFF�tIf-RLEEN (SAN JOSE) INC. t; Fatuity's Phone L L <br />Y'% Y.1 10218erryesa Road 1-408-451-5000 1 <br />Q �A is j0 45 )9 4 9 4 3 1 10 <br />San Jose, CA 95133 i-- <br />2. Con!airwrs 19. Tota{ 'w L.toit I- Woaffi Number <br />Q ,� QuoNity wt/vol <br />_ — <br />11. US DOT Doscriptio,' ii-ndudin� Fropor Shipping Name, Hazorci C1ess, and ID Numbat) _ S <br />V Z1 o. <br />3111) G l a. ' I-StotWc <br />thar <br />oa E z. go ! / U/t,l,1 a —�-- _- --` - State <br />-4 R _ <br />A EPA/Othar <br />o T <br />state <br />W d. EPR/Other <br />LLA <br />44 <br />g <br />�a <br />a <br />C <br />a <br />ti <br />T <br />L <br />1, Additional De+rriptiona Icr Materials listed Above b. JL4/ <br />t j f D -t <br />15-17 d. i`'It t <br />Proflie# <br />1.. Special Hancline Instruction+ and Additicnol Information ll <br />24 flour Emergency Resppoonse Tet. No. CHEMiREC 1-$00-424-9300 g4t6 of Lading # 7 /87 <br />g;R(; iP�ar protective clothing r <br />Sales Order # <br />r-^ <br />marked, and labeled, and ora n o'd rospects in Fropnr Can <br />for transport y r, gh .oy according la applicoble mtnrnatiarwl one national gaoornmort regulations. <br />16 GENERATORS CERTiFICATtoN: i hereby declare that the con+onts of Chia eanaignmant o e F ify and eccurotafv cascribed above by proper one 9ng na'na and ore Ciesai tee, poC <br />b aneratad to the degree I have denannined to ba econar.ico9 <br />IF I am a large quantity generator, 1 certify that I hove a Frog8rom in aloes to reduce the volume end toriaiw, of waste 9 <br />pradicoEsle and shat I have selected the raeticoble method of treatment, storage, or disposal curranily avnilable to me which minimi.as the present and Ii morsture areal to human that <br />and the to ann W I OR, if 1 om a small quantity generator. I have m.'ide a grad fniih effort to minimize V waste generoten and select IF,e best waste matagcs <br />ment method flat is <br />1 avoibbfa b ma and Phot t can all ----" Month Dat, "e' <br />F !TypedNama � 7 Z1z- 4-2 + <br />W <br />T <br />17. Trans orter 1 R cknowledQement of I <br />W-, <br />w <br />Psinted/TyP ease f <br />1 VE <br />S <br />// <br />Hd <br />u <br />P <br />8 <br />ut16 T rn oer 2 Acknowledgement of <br />O <br />R <br />Prtnted/Typed Nome <br />Uj <br />1 <br />+` t <br />.4 C, /C/.4 C 1yit <br />I9. DiscrapantY traicolion Space <br />IItQj <br />t Z <br />F <br />I' <br />( <br />20 Paciiit' Owner or Cp�rctar Certili< <br />1 <br />Y <br />Fri d/Tjrped �.N.yro.+myya/� <br />11-W= <br />i <br />{ <br />{r <br />GT% 8022A (1199) <br />EPA 87aa-22 <br />Signature <br />e---+ <br />`Year <br />Yaor <br />our mcteriais covers itis manifest exct/at as nolna m_nam i �on ^C,ay Yea <br />Signalur <br />DO NOT WRITE BELOW THIS LINE. <br />\white. ?SOF SENDS T115 CC PY TC 015C WITHIN 30 DAYS <br />-o, ? O 6,< 3u0C. Sacranerto, CA 959.2. <br />