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SK SHIP# 230P63525 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number la 2.Page;of 3. m _R s e Phi 4.Manifest Tracking Number <br /> WASTE MANIFEST SD7 j f( � 1007276973 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Ch++eata Freightlines LLC <br /> - 1110 S. McKinley Ave <br /> LI•i1-HROP CIA 95330•-0000 <br /> Generator's Phone: 209-599-0777 a <br /> smrter,l ria �arp� U.S.EPA ID Number <br /> �aYS'i'xMS INC TXRQf00061205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CI-E(Iii HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address (..UAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 10:1 H) RRYESSA ROAD <br /> SAN JOSE CA 95133 <br /> 408-441-0962 CS) t05'3�t'�4:;1a <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(inci,40g Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1. N )N'-RCRq HAZARDOUS WIPISTE, SOLID DINT P :='c'`? <br /> O (011. F11-TER S) <br /> LU 2. <br /> w <br /> 3. <br /> A► <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD;SJ <br /> 81862689 C:H46348 CtiiCi t <br /> 24H E*-RGENCY#800--469--1760--CH/SK/TFI--Contract retained by generator confers aggency authori y <br /> on initial transporter to acid or substitute additional transporters oin enerator' s behalf. <br /> 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, <br /> marked and labeled/placarded,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 consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generatot'slOfferor's Printed/Typed Name Signature Month Day Year <br /> 16.International Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of MaterialsLLI <br /> y <br /> Transporter.1 Printed/Typed Name Signature Month Day Year <br /> r l; <br /> a <br /> Zer <br /> 2 Printed/TypedName Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ra Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 11 <br /> u, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � <br /> 1. 2. 3. 4. <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 Fot7111'817Q0y2 p7v. L1 Pfrevious editions are obsolete. GENERATOR'S INITIAL COPY <br /> 1 i r87QO-i ..�f 1...0 ! I <br />