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SK 0141P# 22'7891406 1111111111111111111111111111111111111 <br /> Pleas©print or type. Form Approved.OMB No.2054-0039 <br /> UNIFORM HAZARDOUS�Gewator Number r 2.Aage 1 of 3.Emer any Resew se PhQp 4.Manifest Tracking Numbor <br /> WASTE MANIFEST E:AIJ �1'1 (.3 Jai 1 1_.fir '-�1�8-1 T��� 1 ,006953239 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(Itdifferent than mailing address) <br /> Di.e�,e! Direct West Inc <br /> 3861 D'AQk Creek Dr, PO BO)i 31086 <br /> STOCKT ON CA 95215--7956 <br /> Generators Phone: 916-837-1000 <br /> 6.Trans er t Com ny arae U.S.EPA ID Number r <br /> SI�I��TY�_AVYN SYSTEMS INC TXI"#00008120 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> L;L.,I-AISI HARBORS S ENVIRCNMENTAL SVC INP— MAI10::9 32 r':250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JSSI* U.S.EPA ID Number <br /> 11�1r 1 BERRYIESBA ROAD <br /> SAN .'fHS� � CA 95133Facility's Phone; <br /> 408--441-0962 <br /> ga, ft U.S.DOT Description{including Pmper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Packing Group{if any)} No. Typa Quanlily Wt.Nol. 13.Waste Codes <br /> t. NON RCRA HAZARDOUS WASTE SOLIDS, (LISED � DM � P 352 <br /> o OIL, FIND ABSORBENTS) <br /> z 2. <br /> of <br /> 3. <br /> 4, <br /> 14.Special Handling Insh eflons and Additional information TSI).-SJ 794-42751. D I`1596 36 <br /> a l ID7ZO1 <br /> 24H EM R ENCY#800-4 8 -x760 -Cli/SK1TFI•-Contract retained bygoner or confers a�galr4 y authorwi <br /> tn add D. additianal Es Din <br /> 15. GENEPATOR'SIOPFEROR'S CE TIPICATION: I hereby declam that the contents of this consignment are fully and accurntely described above by the proper shipping home,and are classified,packaged, <br /> marked and labeled/placarded,and are in alt respects in proper condition for transport according to applicable International and national governmental regulatons,If expert shipment and I am the Primary <br /> Exporter,I certify that His contenls of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minlmlzallon statement identified in 40 CFR 262.27(a)(if I am a large quantity genera or(b)(if I pril a small 4nfily generator)Is true. <br /> Genorator'sloiferoes Printedffyped Name Signa ra Month Day Year <br /> G ' [C <br /> j 16.International Shipments ��1t <br /> ❑import to U.S, El Export from ll. , Porl o entryfexlk. __.._ <br /> ? Transporter signature(for expnrls only): Date leaving U.S.: <br /> W 17.TransporterAcknoWedgment of Receipt of Materials <br /> � TranserlPdnled ?dame Signature � y M pa Year <br /> n 9 09 <br /> z 7758parter2�P me amo Signature Month Day Yaar <br /> 18,Discrepancy Ip p—� <br /> 18s.Discrepancy Indication Space Ouandty Type 1 1 Residue t__1 Par#al Rojlrl ❑Full Rejecllon <br /> Manifest Reference Number. <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> v <br /> Facility's Phone; <br /> f 6r..Signature ofAitemale Facility or Ganomtor) Month Day Year <br /> 2 <br /> 16.Hazardous Waste ReportManagement Malhod Godes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. <br /> 20.Dasignaled Farahly Owner or Operato.Cerdfi don of receipt of hazardous alert°s covered by the manff noted in ham 18a <br /> yped NSi . <br /> EPA t o� 2a(Ravn <br /> 8 <br /> 70 <br /> 0-2 _12 7J f�revious editions are absoletas DESIGNATED FACILITY TO EPA's e-MANIFEST SYST M <br />