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RECEIVED BY SJC EHD (EF) on /1/2020 ,rsOL SHIRii` -B-4- 4 <br /> ' t�lease 'rintor -ec.;:' . Form cued.OMB No.205( UO39 <br /> 14. <br /> Approved. <br /> 1.Gbneretor ID Number 2.Page l of 3.Emergency Response'Phone Manifest Tracking Number <br /> t1NIF01tM1_HAZAT2QOU3. 1l�libl�&f:#e.}'c:�:'l 37• .:•�^•t3tb�s'-4�t:1w•�.•�h4i (� <br /> WASTE MAN[FEST 007 <br /> i � [O <br /> 576ertciatoes Name and Mailing Address GenereWs Site'Address(If different than mailing address) <br /> V71"t Busilxrk ,CiR:i: c:�u �1► <br /> 1740 Houotovi Arra <br /> sOCKTON CA 95rOP-'1211" <br /> Generators Phone: <br /> j 8.Transp6rier i Company Name U.S.ETNumber <br /> SAFE—iY--KLP-EN INC <br /> 7.Transporter 2 Company Name U.S.FEA ID Number <br /> CLEAN HARBORS Envy SVr, w. MI32i 5 <br /> 8.Designated Facifity Name and'Sfte AddressU.S.EPA ID Number <br /> -CLEAN HARBORS GRASSY i��'UNTAIN <br /> :t MILES EMS e,' 7 AILEG NOPTH ktPli3i_j.S F-WI ' #!; w; IF 1--no <br /> it <br /> KNOLLS <br /> Y UTEiji 0H?r <br /> Facill•s-Phone jF3�-8+ �►"-&31 UTD99. 1301±446 <br /> ga r�L 11:S-DOT DesciipWn Qnduding Proper Shipping Name,Hazard CI9ss,ID Number, 10.Containers11,Total 12.Unit ' <br /> 13.Waste Codes <br /> NM and Packing Group(if any)) No. Type Quantlty, wuvol. <br /> MW NON--RCRA .HAZARDOUS WASTE, 301.107 P 3roe. <br /> rat L, W AT',,. SAND, FISSORBENTS ANDP. —Irlis <br /> w <br /> Pwwwq <br /> 3 <br /> 1 r <br /> 4: <br /> 14:Special Handling Instructions andAddilional Informatiotl <br /> 1 �521�C,)a! S2Ei3�5 UA 234eCS02 <br /> 2 4 EMERGE`ICY#800-4t 8 �7 ��.GH15�(�:�FI--Cr�nti�. t re%,ained by-R' net^atgr cfaTIFer45 a. tt y' ItiawM:��t <br /> t 1 <br /> ' 15. 13EN T1Nt'S! FFE OR'S CE IFIfATION,:l hereby declare that the cWtlents o tins coftnmenl are fully and acairalelydescnbed va by propers Ipp name,and are ed,'packaged,> ' <br /> marked and Iabeiodlplacarded,andatB,1�altrespeds.fn:proper conditlonfor trensporf according to applicable t�tem���al e'nd national governmental regulatlons,If export shipment and I am the Primary <br /> Exporter,I certify that the oonteMsgt)h*.gpnns)g(unettt confonp to ihet2rms btlhe attached.EPApcdcnavledgmenloTConsent <br /> f cerlHy that the waste ralnlmizatio.-#kii raittil4r4fted In-40 SFR 262.27(a)(If I am a large quantity gegerator)or(b)(if f yj a small quantity generator)Is he. <br /> ator s/Offerors PtinEedfTyped Neme'; gnah re Monnth'. .Qay. Year.. <br /> ` 1 nternational Shipments <br /> ❑Export from U.S: Port of entry/ad:, <br /> -•�:: I�1�. .l� Jp Y4°71,.''-�'�=.4'.:v' _ .� "<7��.�:.:. ;:�.jx-..�j�t�-itin.34 u'.��.:r1Cla'ap�ea•nlrr:V:.�: _ �'�� - <br /> tib.. <br /> :'' �i<. :Acjd'nY'10d�fi�.P1.aot:Msferkla •.s '<,,:� �'fg!"••:: :'.K <br /> -r <br /> Cr r <br /> Y A: <br /> !e:'^ •;� •:� - 1• '.: :-; ,•• t gnih::.'1:Da .Year.. <br /> n ., !,b• -kaleu':.r;,,.;,; :a:r '.4att:: .�gnagre :.y;..:,; n:rrc. ..r':'.t:iE� y. <br /> :� '4✓y-:,.fyt:.,t•: ,:�`.: '.c:y s,• r;;:- rY.>` ..Y,.,•`a.:-: gy <br /> ,ti• <br /> f f:rr6 a 4, `i <br /> 'R• <br /> r� <br /> Cr <br /> ' <br /> fl 1s.D(sixepancy ` <br /> 18a.Discrepancy indication Space t—I tatrent 0 -pe D Residue 1-�.-F <br /> Y TY u Parl(ahR*edo n Q Full keJectlod. <br />