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Pleaseprintorfype,{ orwdesi nedfdr'v eoh,+31i#��12'-iifr tjf�pev lfer.) � � ` formved 0PA9Na;.2f)50009 <br /> UNIFO&KAZA06Ug 1.Generator ID Number 2.Page 1-of 3.EmergancyResponse-Plane 4 ManifastTraekl :Number <br /> WASTEMANIFI T:: .> s -� 9R,.. 0 0.- 753839 FLE <br /> 5.Generator's Name and Mar'k'ng Address Ganerators S'deAddrass(1(different than malting address) <br /> RAI <br /> ME <br /> Genersw'atoff-42091491ATTR:R3VMorrft:Sei2s <br /> 6. ransporter I companyName U.S.EPA ID Number <br /> Clean-Harbors Enviranmentai.aeMoes I tr-: ... . <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CIean.Hariars.9an dose LLQ t3' <br /> 1021 Bef"ryessa Road <br /> s 'Jose:CA'95i33 <br /> Fool' Phone: <br /> go. 9b.U.S.DOT Desotfptfon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> yM and Packing Group(If any)) 13.Waste Codes <br /> No. Typo quantity Wt.Nol. <br /> 1•UR19,993.WASTE FLAMMABLE LI>rJUID..S.N.O.S..(ACETONE. 29.2 D00i F003 <br /> X METHANOL),3.PG III <br /> z 2. <br /> ru <br /> c� <br /> 3. <br /> 4. <br /> 14•Special Handing Instructions andAddtional Information <br /> I.CM24$8l ERG&9128 .. <br /> ,?Cs � P 45a4-2— <br /> 15, GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledfplacarded,and are-in all respects in proper condition for transport accordarg to applicable international and national governments]regulations.If export shipment and I am the Primary <br /> Exporter,I cerb(y that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I cartity that the waste mWmlzation statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or (if I am a small qua ' erator)is true. <br /> nerato�si0tiero�sFfinteffype8 Name a mom Day Year <br /> —i 16.Intemational Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit <br /> Transporter signature for exports onl : Date leaving U.S.: <br /> 17.TramporterAdcnowledgmentofReceipt ofMaterialsUj <br /> . <br /> ransporter 1 Printed/Typed Name Signature. on ay Year <br /> Te' 'R2 t.j Yr -- I t Z.I If 1 t <br /> Transporter 2 PrrnfeNTyped Name nature Month Day ear <br /> F <br /> 1$.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity <br /> 1:1 Type ❑Residue <br /> ❑Partial Rejection ❑Full R*d., <br /> Manifest Reference Number: <br /> .18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> U. Facil' 's Phone: <br /> 18-Signatn of Altemate r-adity(or Generator) Month Day Year <br /> Q <br /> W19:Hazardous Waste Report Management Method Codas(f a;codes for hazardous waste treatment disposal,and recyrdint;systems) <br /> Uj <br /> 20.Designated Facility Owner er .OporatDr.Cergfiatiort of receipt of hazardous materia covered by the manifest except as noted In Item 18a <br /> PrinfodffypedName Signature Month Vay Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO,DESTINATION STATE(IF REQUIRED} <br />