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SK SHIP# 22698i.21481 Please print or type. Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number r, xr„ 2.Page 1 of 3. me R s se TT 4.MaWnflest TrackIna Number �[ WASTE MANIFEST 1 r m�t l TTA,, 1006687336 S ISS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Ca'-Trans Sha( 10-- 30110 Nc 1.t'013ofBst STODKTON CA 93206-1-4 1 209 Generator's Phone: 2 --946-761.: 6.Tr?fiporter�Gojr la amg SYSTE MS I NC U.S.EPA ID Number T x R01?l0061.i40 7 Transporter 2 Company Name U.S.EPA ID Number 1_L E AN Hf-19F3DRS ENV Z S21JNMEl,1 E`AL. SWC INC. IIAD039322250 8.Designated Facility Name and Site Address CLEAN HAR.bORS SAN JOSE U.S.EPA ID Number 1021 BERRYESSA RdAD Facility's Phone: SAN JOSE CA 9513S CAD0594943iO 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. X t. NA3077 HAZARDOUS W HiT-E_p �.CEE„_I17, N.,0. S. P r., P 1?0t 5 t)t11OF I?a307 o (L)AI), f;E ROMTUM) t'[3 I i i �1 � -- D008 161 w W 2. NON E�!X4 1'IP17.AF21jOUS WASTE SOLIDS ?orf P 223 0 (DEBRIS, PETROL FUM i-f't DROCARhClO i` ? 3. 4. 14.Special Handling Instructions and Additional Information TSD:SJ 78It76`3181 CP48fV2 I)kR13#1112 2,41-E EMERGENCY#800--eq-,8_.1760--CH/SK!TFI--"otitract Y,etained Dygenvy,a.tur- cone 's a envy authar'i y an initial transporteii- to add or 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator'sl0fferors Pnnted/Typed Name Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: Lu 17.Transporter Acknowledgment of Receipt of Materials Tran§porter 1 Printed/Typed Name Signature Month Day Year a Z Transporter 2printedrfyped Name Signature - ! Month Day Year 18.Discrepancy lila.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J_ V tai Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z V519.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2, 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnntedrryped Name Signature Month Day Year EPA Form 8700-22,(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY i)8149-1+1 1/174L5975