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800 E. Pescadero Ave Record ID# PR0514340
<br /> 11/20/2020 Program: HW
<br /> Photo 25: The following uniform hazardous waste manifest (006461715SKS)with signed designated facility copy.
<br /> mrd Coater INunibarsnd Typed warm en _ J// SSL e+t 6�{IPM�9O0r - .
<br /> enter lea number armnlainem int will d The ap'-Pmfe dbbredadon from Tema l Please part a a type-066 deigned for use on eels ll2-pitch ,} Form Appiral OMS No.2050.0039
<br /> W ooTaeaala {o l br rhe type ertlWlamer. I Geaamld lD Numaer 2_P 1
<br /> sin hwe TABLE i.-TYPES OF CONTAINERS UNIFOFE-01IFE HAZARDOUS "1 a Reap3--Prwna 4Menaeyt Tracuin Numbs
<br /> wAsrE MANIFEBT CAL000138135 1 F 8 p68-1760 0 0 6 4 91715 SKS
<br /> d%linea w ti4=Buda P•crom.paper,or pfasuc bags. OT=Ovmp rmdc.
<br /> Mala lhfs farce CF=Ffbor or plastic bel call cases, DW Wooden drums,brrels.haps. 5,r;orcwawarxma and Mailing gdtlress Geraelane SlN Wd'easmelRennlaan malMg addmssl
<br /> iY22A1 far CM=1i hones,ceeons cases bnduding HG=Napper air Sal ram Penske Truck Leasing
<br /> . mIfofs7. 8000TRACy Pascadera Rye
<br /> CW=Woodeabobes.ranans,rasas. r r CA 95304-9799
<br /> C-Talk cars. ceremtare Phew' 209-8.30-5050 _
<br /> CY-CylmtlerE- TT Caltabre Tands gTm tCOrn �� U_S.EPA Ip Numher
<br /> OF=qbe Evilrpresec dorms,barren,kegs. rT=Gbipo;anus need uupcS) Sf7FETY-1(��EN 9YSTENS INC TXR000081205
<br /> ., ^ � nkr-Melaremma,harreh.dega.
<br /> A^Ilfem 11 T"ia101anlgy 1.Tmnsopnar 21 Name U.S.EPA IO Numher
<br /> Enver,Indesrgnaledbovas,melpielquanlirypfwasre Ronndpeme1unlm0olhenearel CLEAN HARBORS ENVIRONMENTAL SVC INC, MAD039322250
<br /> whi wrill domlenierdwYmalsarheati0na To the extent prarsral.repan 4uanebas aoedg"a>sa FauNy Name and rgwAdaaw CLEAN HARBORS SAN JOSE US EPA ID Neal
<br /> sing appropriate Vass or measure&m wllf allow you m myon qua1l wkh Trial cison I
<br /> ac1021 BERRY£5SR ROAD
<br /> Walla quanaaea enferad should be basad on actual meas u,,—alswmswmbl curate
<br /> esumares ar asrher quanll5es shipped.Canralner capaoues are not sareolaae as esumatas. SAN JOSE , CR 95733 CAD059494310
<br /> or herr,r2 Units v Ave— Fa Ji Pnonw 408-441-0%2
<br /> ry/eghrNalhmeJ
<br /> Enter m designs red bores,the appraprra is BbbreWehpri imm Table 11 fbelowl for in,on li of ga. as.U S.DOT o1"Itian(irlh g Proper Sh leg Name.mill mass,In Namber. 1o.containers 11 Total 12-UnlS
<br /> Form TABLE R.-UNI
<br /> meesure. -914 ane PacXlrrg GrWp{IlanYb Ne Type Quantity 1Z 'll 12 WdalO Codes
<br /> TS OF MEASURE r.
<br /> G-Genana squids onlyJ_ N=cubic Mdrers_ o NON RCRR HAZARDOUS WASTE SOLIDS DNI P 223
<br /> x=1GI rams. P
<br /> (DEBRIS, PETROLEUM HYDROf.RR8ON51 (7 S
<br /> 09 =Payrrda
<br /> event L-Liters;!;quids only; 7`=Toesf2000Paunosi
<br /> M=Metric T-5(1000 kibgramsl. Y=Cubic Yards, i 2
<br /> able Nod:Trina,Ml Tans,CIIbIC Meters,and Cubrc Yards should
<br /> cwrtecaon wIN only be reported pt
<br /> n very IargebWk shipments,srairas rat cars,lank ticcc*s.wbarges.
<br /> Ilam 13 Waste Codes 3_
<br /> Enter up to six federal and state wade codes to dasoibe each wawa stream genu ed in Item
<br /> gb,State waste codes that are not retluntlanl win federal codes must be entered hare,in
<br /> 4ealToth.federal wssle-des wh-h are most Copra-senWbre of the propel of ere
<br /> waew a
<br /> n !lain 14 Specvally-oh-g Malruiff—a IdAdoid aeflefemse-
<br /> 7_Geaemrors mayenleranyspeaal handling ar shipment-s,perific information ne�ry for
<br /> rhe proper menaesta for Val ofemafenals aFor's launder the geireaoFel 14.Special Handling lnsWcuona acrd Addilianal......
<br /> dlersordeallion T5D:B.I
<br /> hanbasinea5 Sr-h as wasle waste Po oumbern
<br /> rs, ntalner meas,bar moil 760026 AE239S1
<br /> or response gwde numbers_Generators ars%may use Ibis spare to enter additional
<br /> descapare informaaon about they sh \ '1
<br /> ipped matedars.win asrnemiwlnames,mns8luem 24 HR EMERGENCY (i1-600-468-1760 (CH / SH I`TFII
<br /> percengges,physicalsrele,wspeof 9caavdy'ofwastos idelftwersh volume"has to
<br /> lain 12.
<br /> is. GErk d aid 1 10FFEAOR'S D9RTIFICATION:Thrill
<br /> ecfere Nal are rnntema d his 10igrenenl am Nry ortl aoaaatey deacdhetl shore by the proper sNpgng name,allre dasaifiad,gackagau
<br /> 2.This spare may be usedW retard limited types a/federally requited information for which marketl and labeledrprecartled,and are in au respects in proper mndibpn for real somrding to sppiicahleintemetpaaiantl national ouemmenWl
<br /> there 4 no specific spar provided an Ne manilas;including any a8emaa faafiTy Faparler,l cel That ate contents of Mrs oonsignmenl real to me Tema of hill attached EPA Ack 1 g reguladona.Ir ex port shipmealandlamlhe Primary
<br /> designaaons;the maadestbaDe rtumderol No Icengy Matme waste miramvaao"shatemant idenafietl in l0 CFR 282,27a dlamala a "anti noir adgmenlMConaem
<br /> g Piginal mandrsl for tefeded wastes antl III' r9 4 lige lam uquand generelorl is sue,
<br /> residues that are ntshipped undera sewndmanifespand Nespeafidbon ofPCB waste GenemMr'sl0fiemra PrfnWMyped Name Igrawre r,Generators
<br /> require
<br /> ouly Monty ➢ay Year
<br /> nd PCB af-service dales required under 40 CFR 761.207, , '
<br /> +del"i"Poons eaur Snot be required to enlerrnformapon m"Spam to meal state regul[l -,i18.Jr mafided Shipments v 02 O"l I J
<br /> I- LJ to U_S- ❑Ua U.S. al arrhyreait
<br /> 'f5 Gerrerahr/sKMam'rs Cerlifiralrons TmnsporWrsignawre(ioruwpods treys: Dere leading U.S.,
<br /> The generatormust read,sign,and date Ire waste ronfmizdl sertifirafion statemenr.inTm"spolWrAokroxiatlgmeni ofRaraipl ofMaterlals
<br /> signing eta waste minfnredpon celffthon sbatem-T.Those generators who have eat Trenspartar 1 PdnWtl yped Name SignaNre
<br /> been eVnipted by statute or regulation from the duty m make a wash!mmlmeafion O Month Italy yl
<br /> mri frrapon underseClion 9002(b)01RCRA are also Derfdymg that they have mmpfietl y S-1:VE r
<br /> rriN Me waste mmimizabnn regrriremerty,_The Generators Codification also inmates the Tmnsponer 1 �� Signevre, -
<br /> .��` ➢a Y
<br /> squired allestabao That the shipment has been properlyprell and is in propor
<br /> andifinn ler Transportation(Ilia shipper's cerClrcogonJ. The melont of the shipper's } 18.Disuepancy
<br /> rofra qn atalementig as fultows:'thereby declare that the col Ls of Nis
<br /> ndgnni ami ly and accurately,described above by Ne proper shipµng name,and Ida.Cisarepanry lndiradon bpam Ouantlty Q
<br /> classified,padiaged,marked and is olsh piaCarl and are in afi respects in proper Type ❑Rel ❑Partial Refadlat ❑Full Rejection
<br /> 'dilion for trang7od aanrding In applicable intemadonal and national goremmenial
<br /> dations.f(earppd shipment entllemlhe Primary Erpoder,I that he mritents of a86_Ntemele Fautity(ar GenamWrl Manifest Raferenca Number
<br /> �7nsgnment Annlarm to the terms of the 11"Ched EPA Acknowledgment of Consent." U.S.EPA 19 Numher
<br /> I a parry other than the generator prepares The shipment for transports non,Nis party,
<br /> also sign 61e shippers certifloaMi S48mmenI as the epefor of Me sherni1. LL I'salilys Fhone-
<br /> ralor or0fferor perwnnel may pmplMl the words,'09 behal lh Ne signature w 18c Signature of Alternate Fit Illy(or Generator}
<br /> or may hared write Nis Ste remenl In Me signalure block pnor 10 signing the ¢ Mureh Day rear
<br /> Itorloileror cedi8Pa6on,to mdj,,,m Thal the mdMdual signs as Me employee of agent a
<br /> lamed principal 2 19.Harartlous Waste Report Management Method Codes f.a„weal for hazardous waste trestmanl,di9posal,and
<br /> of the above mfolmabon ez[epl The handwdtteh bigiall required In Ilam 15 may w l recycling systems)
<br /> lied. IO 2.
<br /> I 20.Designated Ft ilii flamer or Operator:Ceriffmi of re,ei t f hazardous materiels mV rod by the manifest except eSrWdin aI 16a
<br /> {Ill Pnn ypetl Na Elgnahire -
<br /> / ' MoDa Y 1
<br /> EPA Form 8700-22[Rev.3-05J Plavlous editions are bbs➢lele.. -
<br /> 1)
<br /> 7776830/118 9197 DES ATED FACILITY TO GENERATOR
<br /> JASON GAITAN, REHS Page 25 of 34
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