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yo� yx rxzP4 *r <br /> lease print or type. <br /> 1 4 462ow6 <br /> Form Approved.OMB No,2OW0039WASTE MANIFEST U 007314462 SKS <br /> 5.Generators Name and Mailin?Address Generators SileAddrew(it different than mailing address) <br /> 7.Trans offer 2 Company Name <br /> q -NV 42VC-t U.S.EPA ID Number <br /> 8.Designated Facility Name and 5ileAddress CJ.-FAN HARBOR SAN jF�.T U.S.EPA ID Number <br /> ga. 9b US DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contaii ers 11,Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.No. <br /> PCPA HAZARDOUS WqSTE, S01, <br /> CIO <br /> 14Sp-cial Handling Instructions and Additional Intonation TE;F) Sj IS i SP-86111 P <br /> � <br /> � <br /> ' <br /> ' <br /> � <br /> ` <br /> ��. ' <br /> ' <br /> 15. GENERATOK'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this wnsIR!"Peot are fully and accurately described above by the proper shipping'difilil are classified,packaged, <br /> marked and labeled1placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shillfhant and I am the Primary <br /> Exports,,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> � I P4=20ft-Offerot rintedi Name Signature Month Day Year . <br /> ^ <br /> 16 International 6hpr1entS <br /> L1 Import to U.S. Export from J`8. Port of oni <br /> LE Transporter signature(for exports only): Date leaving U.S.: <br /> LLj <br /> 18,Discrepancy <br /> 1 So.Discrepancy Indication Space El ch,swity E]Type Residue P.rtlal Rejection El Full Rejecitton <br /> 18b Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number <br /> F-rity's Ph <br /> 18c.Signature ofAlternate Facility(or Generator) Month Day Year <br /> CD <br /> us 19.Hazardous Waste Report Management Method Codes(i.e.,code,%for hazardous waste treatment,disposal,and recyciing systems) <br /> LLI <br /> 20.Designated Facility C;me -0i Certification of receipt of ba4awli ni covered by the manifest except4cled in Item <br /> EPA Form 8700-22(Rev.12-17)Previous editions are ot <br /> ^ <br /> a�ra�uwm�/��nrrr ---��-- �--�� --'—'--''--T~'~'^~ <br /> . ' <br />