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'8K 814XP#- 9155 :i�a5i' <br /> Please p Int o' pe:(Porm,dealgned(orvse on eli(e{12.=pitch ty oivrlfec) 1 Porm'Approved.OMB No.2050-0039 <br /> UNIFORM I.Generator ID Nut nbaf "' - 2 Pegg 1 of 3.Eme.r.gg_ency RP a�sse 'ne• 4.Manifest Tracking Number <br /> WASTE MANIFEST 0606 637i6$� 1 i-tSl00—T a t�M66 <br /> 00476420TSKS <br /> .5.Generators Name and Malting Address Generator's Slid Address(If different Ifdn malling address) <br /> Alen frostAnc9t <br /> ..Ma1 <br /> 1815 Navy-.Dr!- . <br /> Stockton: C:A 95�06=-1'17A <br /> Generate s Phone:. 861 -� �^6177 <br /> 6.Trane orter 1 Compan Name U.S.EPA ID Number <br /> S. FFTY—KI.. EN SYSTEMS INC. TX'ROu0081205 <br /> 7.Transporter 2 Company Name U,S.FPA ID Number <br /> 1• <br /> �-���-�-.���:: • <br /> B.Designated Facility Noma and SlleAddrme <br /> CLEAN HARBO S..SAN' JOSE 'LLC: U.S.EPA ID Number <br /> 16181 BERRYESSA ROAD ' <br /> SAS! MSE �. CA 95133 <br /> 4�i6—�t�+1-0968 C;AT�Q�S�Jti'9�,� i�Zt <br /> Feci6 a Phone: <br /> 98. lib.U:S: DOT Description(Induding Rraper3hipphg Name,Hazard 00ID Ndmbe `lg.�olllehere 11:Total •- •12 <br /> HM and Packing Group Of any)) ,� T y INLIft 13.Waste Codes <br /> Type <br /> 1'-.NONE NON RCRA HAZARDOUS WASTE SOLID91 �. DM.' f P <br /> ¢0 (USEh C)xL AND ABSORBENTS), N/AM. <br /> LLJ <br /> 2 <br /> . <br /> 4. <br /> 14,Special Handling Instructions and Additional information <br /> Mill . .' . '665@179 81,35971' `: GCa <br /> 84 HR EMERGENCY 01-800--468-176101 iSA ETY�KL•EENi: OCR? <br /> BK AUTHORIZE)) Y CE SF rll 9 NT (:AR J E +, c <br /> 16.•GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fullyand accumtelydescribed above by Ihepropetshippingname,-ard aradami6ed,-pedta�etl''. <br /> marked and labaledlplacarded,and are.in all respects In proper condition for transport according to applicable fnternationaland ria0onal govemniental regularyons If expOdsh pin frit end I sn Uiepackeiy <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Consent. <br /> certify that the waste minimization Nalemani tdentified In 40 CFR 262,27(a)(if I am a large quer liy generator)or(b)(If I am a sma I quahilly gar ierator)Is Inia <br /> Gene tor's108eroesPdntedfrype Namti3 :r^ Slgnaiure- �' _ <br /> J Month Day Year. <br /> -.r 1 .Inlernahorial Shipmants //i <br /> I- Dim <br /> port to U.S. ❑Export from U: Port ofentry!&db - <br /> Transporter signature(for exports orgy): We leaving U.9d' <br /> 17.Trans;er erAcknowledgment of Receipl of Matedals <br /> 0: Transpo r PdniedffyypedNa Signature. , on Day Year:• <br /> Q Transporter2 Pdnledfryped Name }' <br /> Month Dey.: ;Year <br /> 18.Discrepancy ' <br /> lea.Discrepancy Indication Span : <br /> QQWN# EITypa !EIPWIdue- PartialReladionF k*c1lon <br /> Manifeet Refarance Number <br /> 180.AltemateFaclllty(orGeneratol- - U.&EPA ID Nwpker <br /> U <br /> rai Facillys Phone: . <br /> LL, .18c.Slgrmlure ofAllemate Facility(or Generator) <br /> Manift -DoZ <br /> 19.Hazardous Wasle Report Management Melhod Cddes(Le,codes for hazardous waste treatment,dlaposel,and recycling systerill). <br /> 20.Designated Fa tiiy Owner or Operator:C 'ficelipn of receipt of hezpr ous rdaledala covered by the manifest ansiplas noted Injw lau <br /> P iniad yped'N�e 7 / Signa re nth D y . <br /> EPA %g editions are obsolete. - <br /> t. QESIGNA7EDFAciuTYT!:GE ERATOR <br />