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Pensa,—(or M(F—eeskined for use Ori elite(12-pitch)type 'ler.) F—AppprovedC0"s No.2n50134 1 <br /> UNIFORM HAZARDOUS i aem,nlw 10 NvnDo, CfiL0Ba316:i96 2 P0a1 1 or atE A v(� � a� ,0 0 5 3 8 O 1 V a7K�7 <br /> WASTE MANIFEST <br /> 6.Durorabf¢N, a rb Meiling Adtheu Garmwbfa Sib Address In dine.enl Man mating eddrC8e1 1 <br /> '. aa and 0V r,r,'.ifo r,n I ' <br /> rcfie O—nrlu :;north St: <br /> rCrTrN CA 95205-7020 <br /> coni I"Ph— .'a7 ..D1-8720 <br /> ra <br /> 6 T1 Comgary U.S.E AID umbel - - <br /> J- �Y—n�c��•.iSTEPIS, INC. <br /> 7 T..,,oner2Compeny Nemo U.S.EaAIDN—oa, - <br /> I <br /> d.Desleratee Faculty N.—efid Slle AddreeeU.S.EPA ID Number � f <br /> CLEAN HATZBORS SAN JOSE LLC <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE] . CA 45133408 1-0962 0 <br /> F rt <br /> F.0 a Phone: <br /> DesaptlM(InUu6rg Proper Shipp) Name.Heard Clase,ID Number, 10.Comainere r• - <br /> 9a. 9b.U.S.DOT rg 11.Tool 12.UN1 a <br /> HM and Packing Group W anY)) No. Type OuanatY W;JVd 13.Waste Codes rb,, <br /> rr 1-fJN1987 LrH'i'i E 17LCf31•tOL SUL IONS ]M 1, L 0 Z L .a <br /> #v <br /> N.O..S'. [."HYL ALCOHOL_), P6 I <br /> r <br /> '- <br /> I <br /> / 3. <br /> 4. <br /> 1 <br /> 14.Special Handling fnstrucuons andAddibonal Information TSL,:SJ 70?_86:,56 aT i72:'.5 C'oti: <br /> f+� E.n!c�tf3F_Nr.: k1-•6210•-468-17 '0 1S1 / IFD <br /> n St R rQRR1F1Rf, Wq NFrFSC;j;"AR4 <br /> r; GENERATOR'SWFEROR'S CERTIFICATION:I hereby dedard that the contents of this eorsignment are fully and accurately described above byte proper shipping name,and are clasi;Aad.packaged, <br /> marceo and labded/placamed,and are in an respecls In proper c'Indldon for transport according to applicable irternatonal and national governmental regulations.it expon shipment arA 1 am the Primary <br /> Exporter,1 mrby that the contents of th's sl nment conformto the terms of the attached EPA Acknowledgment of Consent. <br /> 1 cerdfv Ihat the waste minlmrafft6ml; m dendfied in 40 CFN 262.27fa)(if I am a large quantity,generator)or(b)(if l am a small quantity generator)is:rue. <br /> alo woffemr's Pdny Na sl a Mc',Ih Day Yeat) <br /> International Shlpmer <br /> Import to U.S. Export frc Port of ertrylexit. <br /> Z Transporter signature(fav exports only). Date leaving U.S.. <br /> W 17.TmnsponerAckrrowledgmerrtofReceipt ofMaterials <br /> Transporter 1 Pdnled/Ty red Name Signature Montt Dai at <br /> a- <br /> I.Ar <br /> QT sarrler2Pnnted:7ype �igrptwrr Month Day Ye <br /> < <br /> r scropancy <br /> 18a.Discrepancy Irdicadon Space f�i> e Re <br /> I ❑Fd Rejection <br /> !J Quantity ❑ IJ Residue Partial Re ection <br /> Manifest Reference Number: <br /> F 1SD.A,er,'la:e Fa Fy(or liBn2�alOq U.S.EPA ID N umber <br /> U ' <br /> LL Fecfrify's Phone: <br /> C) 1AC.SgnatureolatteinateFaclity(or uenerator) A4omh Day Yea <br /> a <br /> z <br /> 19.hezarcros Waste Resort Mx'agemenf Method Codes(i.e„codes(Or hazardot;s waste treatment,disposal,and recycing systems) <br /> lu <br /> 3. 4. <br /> :ti.Dasy~)a:ed Facil try Ca me e Orator Certification of rewpi of rdo is materials covered by the manifosl exce as noted in herr l8a <br /> I WJNjlli(fUre <br /> F''.4 Fofm 8700 (Rev.3.05) Previous edtoriS are obsolete. D SIGN AGILITY TOG NERATC' <br /> ' ) 1`70 1009/1 J.036 46) <br />