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SSL SK SHIP# 229461811i��f � �IIII'��al �� �� �� ilil) <br /> O07159086SKS <br /> Please print or type, Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1, Generator ID NI CAL000416532 2. Pege1 d 3. EmapRtAy RGsgopsa <br /> 4, Manifest <br /> 1007159086 NumSKS <br /> WASTE MANIFEST 1 l �tf1W6�9bC� <br /> 5. Generator's Name and Matting Address Genondurrs Site Address Cd Gaerent then waling add'ess) <br /> Con J Franke Electric Inc <br /> 330 No Grant St <br /> STOCKTON 209-462-0717 CA 952@2-2633 <br /> Generetors Phew: <br /> 6. Trofifff ME" SYSTEMS INC U.S. EPAIDNumbar TXR0000S1205 <br /> 7. Transpodsr 2 Company Name U.S. EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8. Des•.gnaladFacility Name and Site Address CLEAN HARBORS SAN JOSE U.S. EPA IDNumber <br /> 1021 BERRYESSA ROAD <br /> k08-441-0962 SAN JOSE , CA 95133 CA0059494310 <br /> FaW Is Plane: <br /> IIIIIIIIIIIIIIIIN <br /> ga. q1. U.S. DOT Description gnduI Proper Shppkg Name, Hazard Class, ID Number, 10, Containers 11 . Total 12. Unit 13, Waste Codes <br /> HM and Paddng Group (d any)) No. I Type Quantity WINd, <br /> X 1 . NA3077 HAZARDOUS WASTE, SOLID, N. O. S. DM t r P D261 352 <br /> o , (CHRbMIUM ) , 91 PG III <br /> z z. <br /> w <br /> t9 <br /> 3. <br /> 4. <br /> 14, j Mal Handling Instructions and Additional Information TSD : SJ 81104008 0082732 en <br /> �.�j GSG : <br /> 1 ) ERG# 17f • `0a " c � � <br /> 24H EMERC>k�NCY#800-468- 1760-CH/SK/ TFI -Contract retained by generator con ars envy authori y <br /> behalfA- <br /> an initial transporter to substitut <br /> 15. GENERATORS(OFFEROR'S CERTIFICATION: I hereby! that the contents of this oo sigtlment am idy and aaumlely descibed above by the proper sh(Pir" name, and era dassi5ed, padaged, <br /> marked and labeted"carded, and are in alt respects in proper condtion for transport a000rd'ng to applicable international and national governmental regulations, if export sh'pnrent and I am the primary <br /> Exporter, I osrdfy Brat 8w contents of Ws mnsignrcanl conform b aw terns of the attached EPAAdmoxledgment of Consent. <br /> I =* that the waste rrinlnlzafiw statement Wertified In 40 CFR 282.27(a) Cd I am a large quantity generator) or (b) (dim a smal quantity generator) is true. <br /> Generaloest or'sprinted7f Signature _ dt 3y Year <br /> I SNpmenis ❑ impost b U.S. ❑ Export tmm U,S. Pat d entry/exit - <br /> ZDate leaving U.S.: <br /> Transporter signature (fa suis only): y <br /> 0: V. TrasporterAdnoMed¢rent of Receipt of Materials <br /> T er 1 Print Name s9nalur Y <br /> ear- <br /> q a ism- <br /> ersignatureMonth Year <br /> Z Tf�sport tn�2 P led+l' __s' `` r,,,�• <br /> moo <br /> 18. Discrepancy <br /> 18a. Discrepancy indication Space ❑ ❑ Type ❑ Residue ❑ Partial Rejadion ❑ Full Refection . <br /> ManBest Relerence Number: <br /> WINU.S. EPA ID Number <br /> 18b, Allemato Fadlf y (or Generator) <br /> J <br /> U <br /> ua Fadity's Plane: Month Day Year <br /> lac. Signature olAftornale Fadlty (or Gemara) <br /> Q <br /> 2 <br /> 1g. Hazardous Waste Report Man art Method Codes (I.e., codes for hazardous vrasle treatIIIment, d'spoIIIsal, erd re <br /> IIIIII I systems) III III <br /> 1 . 2. 3. 4. <br /> 2O. Designated Fadi ata: CerBfica ofrecallpt s lacoveredbyOamenaeslexceptasnoted in 1 <br /> re a <br /> rin yped Name - <br /> EPA F %11 9 fay. 1 s loons are DESIGNATED FACILITY TO EPA's e• NIFES SY <br />