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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 23: The following uniform hazardous waste manifest (006461715SKS) with no signed designated facility copy.
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<br /> Pleese print or tVPe.{Farm tles+gned for"eon etde(12-pitch} hrer.l Fann Approved.pMU No.26501C039
<br /> UNIFORM HAZARDOUS 1.Generator lO Nember z.PagetIN 3.Emerg• Reeparne Phare l'0'"'0
<br /> 0'" r''4"'g7,b 715 KS
<br /> Pease Pr WASTE MANIFEST tiAI_N+71N5 7 t'-r00--'4,115 5;i10 11C AC
<br /> UNI 5.Genera 01 Nemo aM Melling Adi Generomrs Site f dares9(if o-esnt Nan melLng adtlrossl�3
<br /> v Por,5ke Truck Leasing
<br /> 51 300 E Pescadero- Ave
<br /> I TRACY CA 95304-97'19
<br /> canerawe,Phone- 299-830-5058
<br /> e nansparlarl C. Name U.S.EPR€D Numcerc'l'
<br /> .If',f ETY—JSCkN 5YSTEh15 INC
<br /> s 7.T.,Pa.,2 Campany Nemw U.S.EPA IO Nembar
<br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. 250
<br /> e.Oesgnated Fe."Nana and 6aeAtltlress v.s.EPA ID Number
<br /> CLEAN HARBORS SAN JOSE
<br /> w a 1021 BERAYESSA ROAD
<br /> SAN 309E , CA 95333
<br /> h08-441—@962 310Feul'Il sPhone:ga. 9 US,DOT Dasdi'llon(and ng ProperShlppag Name.fiAi Clan,100umbff. 10.2-hinsm 1,., r2odasHMand Padi Groin onYll No Typo 0—my vd
<br /> Fes- rNUN RCHATARDOUS WASTE SOLIDS DM
<br /> IDCBRIS, PETROLEUM HYDROCARBON53
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<br /> In,n^r•<ae�arun. Io-.specialHandling€nsauchoneamAddiarnalmiarmation TSD e33 76002866 PF 2'2' 1 CSG:
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<br /> 24 HR EMERGENCY Ili—B00-468 1760 ICH / 51i / TFI)
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<br /> ^�r'••r!g!r••d 15. GENERA70R'SIOFFEROR'SCERTIFICATION.IhereWdeclarelia�Me can€enlsor thismrnignmentarendlyandacurra!alyeeanbaaaibythepanpiiiiMpirgname,aial olaii Oackagad.
<br /> marked and IaoNetl fapNetl.and are in all re eds inpropercondilia for transport acoordi to a cable In€ematual and national
<br /> !p sp pa rg ppii gwammantal regulations.If expon shipment arrtllam lm Primary
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<br /> of this consignment confirm In the I—of ince 8dachad EPAAck,.W lgmantd Consent.
<br /> '!1^d•r""xrmr IceNly thatdre wastemirgmuatlonsralemenl identiFadin 40 CFR 28227(a)tiflamaWrgequantiry genaa3gr},ctc{b1-taro nquanuty 4eneratoq is We
<br /> .n"iit �• Generaioegiafemh Pant, Name 'gnateta — MaN Day Year
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<br /> p_ ❑Importfi U.S. ❑EYpORmom ll,5, Pert OfeMryre.lr
<br /> •!r••ra!n•^^ Transporlersignalumfia eaportsonty}'. Date leaving u31
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<br /> C-.= W 17.Transporter Acknowladgmam of Receipt of Materials
<br /> °"e v Transporter l PnmedlTypad Now Signature Month Day Year
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<br /> l Sgnature Month Day Ycar
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<br /> „a,g..". I K 2 TrdnspoRsr27nnledlTypetl Name
<br /> ra,,,,,n^., t .F IB.Diswepanry
<br /> ,,s•!'n iBa,Disuapancy mdlcation Spada Ouanty ❑Type ❑Rasldue ❑Parcel Retaction ❑FuH Rejection
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<br /> - � li Manliest Reltani Number.
<br /> un^„,! 1 rip.Allemate FaGhl Generator y{cr } U.5-EPA ID Number
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<br /> 18 LL Facditys Phone:
<br /> 1icB store ofXlemals Faclill aGeneralor
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<br /> 0 1 19.Harardaus Waste Rinpgd Menagement Me1M Caries ti.e.codes for haaardous waste treatment,disposal,and aoycllrg systems)
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<br /> ll Pn 20.Des natetl Farilit Owneror
<br /> rg y Operator:CeNhcaaon df receipt d1 he2ardaus matahaEa wvered by the manlfisl escepl as need in Item 18e
<br /> Pnnledfryped Name Slgnalum Month pay Year
<br /> EPA Fo
<br /> EPA Form 8700-22(Rev.3-05)Previous iii are obsolete. GENERATOR'S INITIAL COPY
<br /> r77:i;3�0;i199197
<br /> JASON GAITAN, REHS Page 23 of 34
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