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rr]A ?! <br /> SK SHIPN <br /> ,it or type. j <br /> NIFORMHAZARD2U3 I Ganareke lD Number r—�x. <br /> WASTE MANIFEST Cql.2316345 a P P;,�,``:-': f"•'E <br /> 5 Ger�ratys Name end Ma;1i Address ] 9 11 <br /> i ""12 p�bC! 1)1j: <br /> N i^G w•mb+• _ _. <br /> Diann Of c 7 SKS ^l <br /> 91050 D3abund SatlthnSt c ralorss�AeeresaMmrte,dlaw.mrv,amre.., <br /> STOCKTON <br /> Geninill Phone- 204-601—A720 CA 452W,-71d2P+ ••, <br /> 8.Trpp);ppryy� <br /> SYSTEMS INC, <br /> u S EPA ID Number „ <br /> 'Transporter 2 C T F F410Q10H! <br /> ompany Nama <br /> CLEAN HARBORS ENVIRONMENTAL 3VC INC. US EPa ID NurrWe ` _ <br /> 8.Designated Facility Nameand Site Address ItiADQ 39�` - I• - <br /> CLEAN HARBORS SAN if, t15 EPA ID NuniDar <br /> 1021 BERRYESSA ROAD <br /> SAN .109F CA 351 3 — <br /> 408-441-0d5r <br /> Facdlry's Phone. _ -- <br /> 9a 9b.U.S DDT Din—pbon(includmg Propel Shipping Name Hazard Cl—IU Number 10.Coma rte, ,,Tolyl <br /> HM and PacJung Grouptifanyl) •'< �3 <br /> No Type GramoN WI`�-.- <br /> X t UN1987, WASTE ALCOHOL SOLUTIONS DM F [rQQi <br /> N.D.S., (ETHYL ALCOHOL), 3, PG }1 <br /> z <br /> w <br /> CD <br /> - _ 1 <br /> ;4 Special Handling Instructions andAddillonal Information TSI)oSJ 78b78 30 1)I172c,b <br /> 1)ERG*121 <br /> 24H Er4ER6E�NCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers a encs authors 1 <br /> on initial trans arter to add or substitute additional trans utters en enera or's behalf. <br /> 11 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name.aid are das ftd.padcaped. <br /> 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 ano I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I cen ly that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We. <br /> Generatofs/txfero/s Printed/Typed Name Signature Month. Day Yea, <br /> If.InfemaUonal Shipments <br /> t•— ❑Import to U.S. ❑Export from U.S. Pon of entrylexili <br /> ? Transporter signature tlor exports only): Date leaving U.S.- <br /> LU <br /> 1'.Transporter Acknowledgment of Receipt of Materials <br /> r— Transporter I Printed/Typed Name Signature Monln Day Year <br /> 0 <br /> 0 <br /> LL <br /> z Transporter 2 Prinfed/Typed Name Signature Month Day -. <br /> 1 <br /> 18.Discrepancy <br /> 181,Discrepancy Indicalion Space ❑Partial Re ecbon ❑Full Re ecf on <br /> Ouanlily iyt'.e Residue ) j�� <br /> I Manifest Reference Number: <br /> 18b.Alternale Facility(or Generator) U.S.EPA ID Number <br /> J <br /> G U <br /> ri Facility's Phone: <br /> P LjjO 18c.Signature ofAlternateFacility(or Generator) Month Day Year <br /> 7-01 ! <br /> w19 Hazardous(Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> I10 Designated Facili(y Owner Dr Operator:Certification of receipt of hazardous materials covered by the manifest except as nded In Item 18a <br /> °nnlc"u""�I ypcd NBITie <br /> Signature Month Day Year <br /> I 1 1 <br /> EP o r �qq i <br /> � a FqV, �17.ryPr vlous editions are obsolete. GENERATOR'S 1N►�lAl COPY <br /> ; <br /> 0 <br />