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SK SHIP# 230044679 Please print or type. Form Approved.OMB No.2050-0039 1.Generator ID Number '2.Pae 1 of 3.Emer an Res �,se Popo;x 4.Manifest TrackingNumber UNIFORM HAZARDOUS CAL@�tb'i374FI2 g i )—59E-)i� e ,y nT, +� O SKS �(n� WASTE MANIFEST O O 3�y 7 L 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) San i Pak Inc 23.535 S BIRD RD iR10f7v CA 95376--000112T Generator's Phone: 209-835-3164 6.TrFpgppr�r.l�Cprr�iy_Nerte SYSTEMS INC U.S.EPA ID Number TXR000061205 7.Transporter f2 Company tName U.S.EPA ID Number HARBORS ENV SVC INC. 8.Designated Facility Name and Site Address MEAN HARBORS ENVIRONMENTAL SERVICES, IN U.S.EPA ID Number 2P47 S HIGHWAY '71 KTMFAI1, a NE 69145 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WtJvol. K ( 1 LIN 1 PIR 3, WA1STF `,ASOL.I?VE, 3, PG !I 0 Z 2. w c� 3. 4. 14.Special Handling Instructions and Additional Information TSD z VP 13 17 12650 1)ERG#128• ?4H EMIERGNCY#800-468--176k1-CH/SKITFI-Con tract retained by generator confers anertcy aUthuri y on initial trans niter tr, add or substitute additiona'i t.^an vortars stn enerator's behalf. 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify 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 true. Generator'slOfferoes PrintedlTyped Name Signature _ Month Day Year 16.International Shipments � ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: C 17.Transporter Acknowledgment of Receipt of Materials LLI Transporter 1 PrintedlTyped Name Signature Month Day Year O CL z Trdnsffrter 2 Printed/Typed Name Signature Month Day Year r 18.Discrepancy 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V rat Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Monfh Day Year a Z t, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) L 1' 2 3. 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed7Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY i)873fOc4j!19c49�,5