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F;K SHIP41 230406911 <br /> Please print or type, 2 7 6 3 5 1 3 K & <br /> Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number <br /> 2.Page,1 of 1.�meggt <br /> Respp 14.Manifest Tracking Number <br /> WASTE MANIFEST 3 to <br /> tI 1007276351 SKS <br /> 5.Generator's Name arid Mailing Address Generatoes Site Address(il different than mailing address) <br /> A 1-1 EE-;e I d v T) rja t r-, ADE113A -- GoTtlen Gate <br /> 18501 West fit anfrjrd Rd, Att'nSamuel mcheBry 18501 Stanford Rd <br /> TRAC'Y CA 95377 Attri Lester Satio <br /> Generator's Phone: -"I TRACY CA 95377-9708 <br /> 6.Tr r;VVFT�d71n0f1aP' GY!'3TF_-M5' INC, U.S,EPA ID Number T X r?(A 00 0 el I i"1715! <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> C1 F'P,N HARB(IRr', F-311V INV" M A F)0 3 r3-1"!'P R'i V) <br /> 8.Designated Facility Name and Site Address C( AIN HARBORS SPNN1,131F U.S.EPA ID Number <br /> 104-2'11 Mill) <br /> A T)0 1 3 it 9 4 <br /> Facility's Phone; C _5 <br /> ga, 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM- and Packing Group(if any)) No. Type Quantity WL/Vol' 13.Waste Codes <br /> HAMIRDOUS WAF-JE, SOLID r)M P r-'P'3 <br /> 0 (011, <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information-- <br /> T�J) T t 4'P'J 01 5 1 Of 0 A 1)2,0 19 8 CqG <br /> P41-1 7rW1-CIVSK/TF1--Grin retained by genera- tor confersa nir�v ar�tfhlari­'y <br /> ciTt aj t ra,n s jt o rt P r to add 0 r F,U h F,t j f,U t r-, ad d i t i o r ta) t r el it s D n r 1,e r 5 pli Q 0 Ft P r-a o-r I S' b e h 61 f <br /> 15. GEN ERATOR'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 Cons.VI <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I all)a large quantity generator)or(b)(if V'Va s quantity generator)is true. <br /> ones ifier rintedflyped Name I ll,mnu]�E Month Day Year <br /> 16.International Shipments I <br /> j. B Import to Ut Export FMV-S.� Port.fentry/e <br /> Transporter signature(for exports only): Date leaving U.S.; <br /> xiT <br /> W 17.Transporter of Receipt of Materials <br /> LLJ <br /> 7 <br /> 0 ""c", <br /> ef 1 Printedawed Name <br /> Month Day Year <br /> A n <br /> CL <br /> CL r3l <br /> ....... iIto <br /> Z Trans r 2 PflintedrTyped Name Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantily El Type Residue Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b_Alternate Facility(or Generator) U.S.EPA ID Number <br /> U_ Facility's Phone: <br /> lltic.Signature of Aittmate Facility(or Generator) <br /> 711nth Day Year <br /> 19 Hazardous Waste Report Management Method Codes(lo,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJI I - <br /> C) 2. 3. 4. <br /> I20. 3. own <br /> Desigrig!ed Far_,'fitY matPrials—covLfedbythe manifest except as 18a <br /> Ptinledfil Name L01 It Signalu <br /> - 2: A t---A" I"T" <br /> EPA Form 8700-?2�(R DESIGNATED FACILITY TO PPS e-M/t4IF_rS_T_1,P_STFM <br /> ,j-YrevirrDs editions Wo iete <br /> '11 <br />