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SK SHIF4 2-'26831442 <br /> Please prilnt or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number QA <br /> 2.Page 1 of 3, me, R s p a PhAn d,Manifest Tracking Nummber (° <br /> WASTE MANIFEST <br /> 6$ �.bi�8 3a., s' # s' tf 1006687444 V KS <br /> 5.Generator's Name and Mailing Address-.- Generator's Site Address(if different than mailing address) <br /> Gai.,.rTr'km! ShOP I%-- MM Cay <br /> 1603 8 B COM CA <br /> Generator's Phone: —M-948 78')3 <br /> 6.Tr $pit p p g U.S.EPA ID Number <br /> "mf"s€„y�N� l +' '�'�' � <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> HARBOR ,NV Z RONM .NTAL Mr, I KPS <br /> 8.Designated Facility Name and Site Address ME;AN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRY SIR ROA) <br /> Facility's Phone; 40i.9-441-0362 SAN JOSE CA 95133 CAD059494310 <br /> ga, 9b.US,DDT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.containers 11.Total 12,Unit 13,Waste Godes <br /> NM and Packing Group(if any)) No Type Quantity WtBoi. <br /> I DOW DOOR <br /> . �k <br /> r=.s let <br /> 2.UJ BION RCRA HgZARDWa WAISTE 50t. IDS (DTPs�d�1 �� P 01 <br /> 3. <br /> 4. <br /> 14.Special Han ling Instructions and Additional Information r IS <br /> ) S 4:T 7 15 2 M 3 <br /> � t ys S <br /> f 3 74 `� <br /> ei;ainr v generakt,'r confers aFanpy at,tthorii,y <br /> :gar t ' r. r I,gbst i tgt d z —,R I ,_teng _an UgnarA,Q0h ' <br /> 15. GENERAL., S 10FFEROR'S CERTIFICATION; I hereby declare that the contents of[his consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marlt6d end-labelecllplacarde,d,'and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this conslgn.monl conform to the terms of the attached FPA Acknowledgment of Consent. <br /> 1 certify that the waste minimization statement identified in Ail CFR 262.27(a)(if I am a large quantity generator)or(b)(If I am a small quantity generator)is true. <br /> GeneraterslOfferor's gPrintedlTyped Narpe Signature Month Day Year <br /> l , <br /> 16.Internati�naf,sftipments <br /> I ❑impart to U.S. ❑Export from U.S. � h orf of ent ylexit <br /> Transporter signature(far experts only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> TranspPrter 1 PgrintedlTyped Name Signature ry Month Day Year <br /> r�''°� ,. r }'......,�4 <br /> Transporter 2 it tedlTyped Name Signature ”` m Month Day Year <br /> dT <br /> 18,Discrepancy i <br /> 18a.Discrepancy indication Space ❑Type Residue [ <br /> .P'artlal Rejection ❑Full Rejeciion.. <br /> Manifest Reference Number: <br /> t 80.Allernate Facility(or Qenerator) U.S,EPA ID Number <br /> Zi <br /> Facility's Phone: <br /> 18c,Signature of Alternate Facility(or Generator) Month Day Year <br /> 2 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1 2. 3. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Fora 8700-22{{Rev. 2-17) Previous editlon5 are obsolete. GENERATOR'S INITIAL COPY <br />