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SSL SK SHIP*'99S'TTJid r iiiii►i►�i�u���u►��i►�auu►i►i►`r <br /> Please pari,N type.(Form designed for use on elite 112-pitch)typewnfer) 0 0�F 2 9 7 6 6 r,i I Report <br /> nrm Ar�n.ed OM3 W zow-0noe <br /> Na at <br /> UNIFORM HAZARDOUS r Gmpafa lD Nwnber CAL000316396 P'grl1 o1 3 - - �� 0 R'rol�rt rr'm"g N„ ' <br /> WASTE MANIFEST 005729788 S^a7 <br /> 5 G`rirnr Ne Nameur�rxai0 Aplre G<nvrubrs Sib Idtlmv Of aiflauN Ran myur,g eaArc.aj Y � <br /> Dl a!•Ond lJf Lia t Denis <br /> 1050 Diamond South St i x <br /> STOCKTON CA 9522^05-707.0 <br /> ceresin s Phone, 209-601-8720 <br /> 6.r &1S'`"� r SYSTEMS, INC. usE-10Numbet TXRZOOOSIL05 <br /> I t <br /> 1.Tran—,2 Ccs- Narre us EPA ID Nwrory <br /> CLEAN F1RIaORS ENVIRON SVCS INC MgD039322250 <br /> 8 Desgrkrled F2allty Nama and soe Address CLEAN HARBORS SAN JOSE U.S EFA IU NumOer `'V <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CR1)059494310 <br /> to-c <br /> FadiN`5 PM ' <br /> 9a. 9b LLS DDT Oesrnpem(indW ing Props SNpping Name.Hazard Class,ID Number. 10.Gontamexs 11 Total 12.Un:l Rep <br /> and Packing Groep fd anY)) No T•rpa Wantily W Wd 1:Na^t,a CoGe�. No. <br /> HM -- <br /> X I UN1987, WRSTE ALCOHOL SOLUTIONS ' -T15 o� P D001 21'2 Mar <br /> o N.O.S., (ETHYL RLCOHOL), 3, P6 }I <br /> w - <br /> c7 <br /> 4. <br /> 1 <br /> 14 Sp—tHandiinglnstruc6onsand AdchionalInformation TSD:SJ DI17225 CSG: <br /> 1)ERG227 <br /> 24 HR EMOGENCY #I-000-468-1760 (SK / TFI) 5V ItYY,V ��t✓/f� <br /> DOTH AS ''AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECE SAP. <br /> t:;. GENERATOR'WOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are tully and accurateiy descnbed above by the proper shipping name,and are uasslfied,packaged <br /> marked and labeleSplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the conlenls of this consignment conform to the terms of the attached EPAAcknoWedgment of Consent. <br /> 1 certify Nat rhe waste minimization statement Identified In 40 CFR 262.27(a)(d I am a large quanfily generator)or ibl(III am a smajanlry generator)Is tme. <br /> Generator Nerol Pri t yped Name Signature Month Day Yeaz <br /> 'L x 10 �7 <br /> r6.IntemaIicnal Shipments ❑Import to U.S. ❑6cpat from U.S. P of rwexi( <br /> f- <br /> Transporter signature(for exports onlyl: a'e Ieaving U.S.: <br /> w 7 Transporta:.Acknowledgment of Receipt of Matenals <br /> f- irppvpter 1 PrintedName Signatur Month Day Year <br /> CL <br /> ads C 1 r� �7 <br /> z Tnnsporfe r eSTyped Name Signature Month Day Year <br /> 18.Distrepanry - � <br /> 83.Discrepancy Indca6on Space ❑Quantty El Type ❑R awue ❑ParW Re ection U Full Re e Gori <br /> Mamfest Reference Number. <br /> 18b.Alternate Facility(or Generator) U S.EPA ID Number <br /> J <br /> U <br /> ra. r_uAfy's Phone. <br /> Aj 13c Signature of Attemate Facility(or Generator) Mor.h Day Year <br /> Q <br /> 2 <br /> C9 13.hazardous Nasllee Re[pocrt Management Meth (iao <br /> Method Codes .e.,codes for hazardous waste treatment,dissal,and recycling systems) <br /> Uj <br /> / F <br /> 20 Co(Desgnatedy�Frapl;ty C wrier or Operator C r5ficatio `receipt of hazardous m�aattenals vered by the manifest except as noted in Item 13a <br /> SI <br /> j <br /> EPI)WJW � U51 cv s editions are obsolete. DATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />