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SSL SN, SHIP# 227285285 IIIIIIf IIl I�I III��I���III�III IIII`f <br /> 0067737 a 3 S K S <br /> Please print or type, Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t-Generator ID Number CAL000087982 e o 3.E�neWpOLy Rp�sppgsa Phop�O /.Manifest Tratking Number <br /> WASTE MANIFEST 1 tl1610 �iGtl 1/ 006775783 SKS <br /> 5 Genererols Name and Melling Address Generators Site Address(if aifierent than missing adorers) <br /> San I Pak Inc <br /> Po Box 1183 <br /> TRACY CA 95378-1183 <br /> Generator's Phone: 209-835-3104 <br /> 6.TrlpSppV ty SYSTEMS INC U.S.EPA ID Number <br /> T.Transporter TX R1�{a00$1205r 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Sue Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> Fadut es Prone: SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> 9S, 9b.US.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 111 Total 12 Unit <br /> HM and Packing Group(if any)) No Type Gunny ''vVvo. %wade Codes <br /> NON RCRA HAZARDOUS WASTE SOLIDS f DM a O P 223 <br /> o (DEBRIS, PETROLEUM HYDROCARBONS] <br /> w <br /> `w <br /> 14 SpedalHandling lrsoucrionsand Additional Informatlon TSD:SJ 78792277 .SA�P74 SG: <br /> ��/�-( � �fB�Ia��Ss� t <br /> 24H EMERSENCY11800-468-1760—CHlSK/TFI—Contract ret in�ed by gen rat or onfers agyency authori y <br /> on initial transporter to add or substitute additi 1 transporters on enerator's behalf. <br /> 15. GENERATOR'StOFFEROR'S CERTIFICATION!I hereby declare that the Contents of this consignment are fully and acaxatey described above by me proper shipping name,aid are classified,packaged. <br /> marred and labeleddplacarded,and are in all respects m proper condition for transport according to applicable mtemanonai and nationalovemmental <br /> g reguWeons.If expos shipment and I am#*Primary <br /> Exporter,I certiy that the contents of this consignment conform to the lams of the et'acnee EPAArknaNedgmenl M Consent <br /> I cerel that the waste mnimizatior statement identified m 40 CFR 26227(a)(f I am a large quantity generator)w(b)(iii am a small quantity generator)is true. <br /> Generatols/Olferofs Prmted,Tyoed Name Sign lyra <br /> " G Cal c draL,4� T` ,l z zs vi$ <br /> 16.Imemalional Shipments <br /> ❑Import to U.S. J Export Iran U S Pon of entry/exit <br /> Transporter signature(for exports onty). Dale leaving U.S.: <br /> W 17 Transporter Acknowledgm nm of Retell of Materials <br /> Transporter t PnotedlTypea Name Signatre Month Day Ve <br /> "s Z Zig + <br /> = Trans rin!eMypec Name Signature ` Month Day Yea, <br /> tt8 Ciscepanty <br /> 18a.Discrepancy,,M:a or SGaca C auanrr, <br /> ❑Type ❑Resicue ❑ParIW Rejgctipn ❑Fwl RefecUan <br /> Marrlest Reference Number: <br /> 1Ill Alternate Facility(or Generaw) <br /> 1 <br /> U.S.EPA 10 Ntanber <br /> U <br /> rai Faall Phone' <br /> W 18b.Signature of Alternate Faahty,for Generator) Month Da, Year <br /> w19 HBZahl Waste Report M t Method Codes(i.e.codes for hazardous waste vestment,disposal,and mcyding systems) <br /> 1 C 1 / 2_ 3.20 Designated Fal r or •ator.Certif ;on of receiot of hazatelous matenals conti oy the manifest excel wed n Item <br /> Pnnted/iypeo ante Signaure Month .,ay_Year <br /> EP7)°f1 4jfjj4'�'4g3'totlsedidalsare te. DE SIG T D FA Y TO EPA's e•MANIFEST SYST/=M <br />