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S ���� IIIIIIHIINIIN�IIINIIIIINIIIIII <br /> _;-^,i SK SHIP* 0069600293 K3 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS <br /> 1.Generator ID NumbCAL000392984 <br /> er 2.P e of 3. me Res P IN 4.Manifest Tracking Number <br /> 1006960029WASTE MANIFEST SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> ti' Re i l l v # 3222 <br /> Ir='00 W f athrop Rd <br /> p9 INT17CA CA 953 3fr-'9ii70 <br /> Generators Phone: 209-239-9606 <br /> U.S.EPA ID Number <br /> s.Trq { v 1 SYSTEMS INC T7R0000F)1 05 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Ct..Ff~N HARBORS ENVIRONMENTAL SVC INC. M4Dv�;9 2�:;0 <br /> 8,Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA IO Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CA 95133 <br /> 408-441-0962 GAD059494?i0 <br /> Facility's Phone: <br /> 9a 9b,LLS.DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1I.Total 12.Unit 13.Waste Codes <br /> HM and Packing up(if any)) No. Type Quantity Wt.Nol. <br /> 1 NON—RCRA HAZARDOLiS STE, SOL.IQ, DM p 181 <br /> o <SS RBENT AND OII_)11 , © ' I <br /> z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD-SJ $1710,'71507 OR10542 CSG: <br /> 24H EMERGENCY#800-458-1750—CH/SV,/TFI—Contract retai e y ge, erater confers agency uthl3r-i y <br /> on initial transporter to add or substitute additio 1 trans orters On enerator' s behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accursfirrydescribed above by the proper shipping name,and are dassdied,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 ceNfy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I cetlify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gene mt s�Offerors PnntedfTyped Name ..�a�l Signature Momh Day Ygar <br /> 16.International Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> 3 Transporter signature(for exports only)'. Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> W <br /> Tporters Pn tedfTyped Na Si Month Day Year <br /> W Transp 2 Printed(Typed Name ignature 1, Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 1- 1 Bb.Alternate Facility(or Generator) LLS.EPA IO Number <br /> Zi <br /> E5 <br /> Facility's Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> y19.Hazardous Waste Report Mana ement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> 1. I 2. 3. 4, <br /> 20.Designated Facility Owner or Operator:Card bon of receiptplAtillZardous materials coveredL the manifest except noted in Iter-OZ <br /> PnntedlTyped Name Signature Month Day1 e r <br /> EPI F 0: 2(ji v us editions are Solete. 7 DESIGNA D FAC TO A's e-MANIFEST SYSTEM <br />