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SSL SK SHIP# 2222@1450 u'I'I' 11IMIN111111 <br /> 0059669098KS <br /> Pleaseprint or type. (Form designed for use on elite I2,phch typewriter.) n y R9sq� PFS form Approved. OMB No, 2050-0039 <br /> UNIFORM HAZARDOUS 1' Gomm " ID Number CAL000416532 2, PaRv M 3. E tlIDYJ 4bH 1 (b@ 4. hkaffest Tro"g Number <br /> WASTE MANIFEST 1 0 0 5 9 4 6 9 09 SKS <br /> 5, Genaaoes Nana ad MAN Address Generenfs Site Address (d dferard than mOM address) i <br /> Can J Franke Electric Inc <br /> 330 N . Grant St <br /> STOCKTON CA 95202-2633 <br /> Gemratoes Phone: � 209-462-0717 <br /> 6, TRWYM ..EFJV SYSTEMSINC U.S. EPA ID Number TXR@@OO61205 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SERVICES INC MAI9322250 <br /> 8. Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S. EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> F s Phan: <br /> ga. 9b. U.S. DOT Desai m (mdakng Proper Shippug Name, Hazard Class, ID Number, 10. Containers 11. 70tat 12. Urit 13. Waste Codes <br /> HM and Pecking Group (d any)) No. Type Quantity WLNd. <br /> ' — <br /> N#203-. —WMT1=SASOLINE, _3,—PG _ II— __ —DK— — @1 d@D0@8 D@18 <br /> Fo Q01 , D01h ) <br /> � ..12 <br /> X 2 - NA3082, HAZARDOUS WASTE LIQUID, + DM P D005 D@06 D0@7 <br /> N. O. S. , (CHROMIUM, LEAD , 99 PG III <br /> D008 D069 223 <br /> X 3. NA3077 HAZARDOUS WASTE, SOLID, N. O. S. DM P D007 352 <br /> , ( CHR&MIUM ) , 91 PB III ds i <br /> a. <br /> 14, spedal Handling "Str"c5"rs anal AddIt" M '°'mason TSD : SJ 73538502 C082732 CSG : <br /> 1 ) ERG# 128 . 2) ERG#171 . 3 ) ERG#171q BY GEN TO RETAIN LICENSED SM CARRIERS AS <br /> 24 HR EMEA&MY #1 '�@@-468-1760 ( SK / TFI )AUTH AS V�C� <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I tweby dedare that the MI" of ftp wnso nxra are * and aoaaatey dawned above by 6a paper s*phV name, and we dasslfied, Packaged, <br /> marked etc labeled*carded, end are in all respect in propercadldw for transport awarding to appgcada Kernational and naWnel goverww" rega5om Iferpat WM*nd and I am Ca Primary <br /> Exporter. I oe" Cat the corderb of dile caromtenl mdonm bo the terms of Ite abd*d EPA A im oledgmentof Consent. <br /> I ow* that the waste mi imtration statement Identified in 40 CFR 26227(a) ('d 1 am a Avg° quern* generata) or (b) (dI am a sinal quantity gasman) is bore. <br /> Genera /r MwLh Day yay.� <br /> 16. ntemafi0nal SNprnkenfs <br /> )— ❑ Import to U.S. ❑ Eport from U.3. Por of enbyde>at <br /> Transporter s greNa (for exyorts onll'). Date lwft U.S.: <br /> CC 17. TanspaterAdmw4edgrrsNofRoe* ofMaterials <br /> 1 Pr'eNf Name Signature Month Day Year <br /> a s a i? <br /> U) 2 Namev v _ SlgnaWre MaMh Day Year <br /> tor <br /> .e err► sw� l <br /> 16. Discrepancy <br /> 18a. Discrepancy IndcatIon Space ❑ ouanuty ❑ Type ❑ Residue ❑ met Rejection ❑ Ful Rejation <br /> Mrjasl Reference Number: <br /> 18b. Ahnate Facdty (or Generator) U.S, EFA ID Nmnber <br /> J <br /> V <br /> 16 Facimys Phone: <br /> LO 18c. SignahueofAlternate Fen'Gy (or Generator) Month Day Year <br /> a <br /> z <br /> y19. Hazardous waste Report Managanarr Melad Coag P.&. codas fortazardous waste beatmem, disposal. and recycling systems) <br /> LU <br /> 20, DesVeted Facility Owner or Opeata. CerllcAm of receipt of hazardous materds owered by la maMest except as noted In Clem i8a <br /> Prntedltyped Name rehue mum Day Year <br /> �(�n plc A 5 <br /> Epi ) 12047@0 414i�7 k5� ) 724@%4@7445@fs 3 ) 7676597? &TMED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />