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SSL <br /> Please prinlvs Re SK 6HIPN 23bb4I585 fIISlIIf4 6����l��I�lI <br /> 7.Generalcr ID Number I Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS -, 2 Pa a cl _E ,cy n p 4. aniks T cki umb r <br /> C flL0003c�J1331 f- sj i dI O �g v ^ <br /> wasrEMANIFEsr `J '.F �,.`�, <br /> 5.teneralws AAyyme <br /> at Mailing Address Gene tors Sit Address(Lf d4lerent Man mailIurg atldressj �( <br /> �UnsLate tqul pArent gUnSi cite tq til PMenC <br /> 5552 E. Washington St. Attn: Annie 8odell 75 E Equipment Ct <br /> PHOENIX AZ 85034--LAOOE1 <br /> Generators Plia. 209-406-&57 FRENCH CAMP CA 95231-&MO <br /> b."" " YWETVTa6YS1El4S IK. u.S.EPA ID Number TXROWN1205 <br /> 7,Transporter 2 Com an Name <br /> CLtAN HAPS ORS ENV SVC INC. U.S EPA ID Number <br /> MAA03432225116 <br /> 8.Designated facility Name and Site Address LLt4N HARBURS SAN JOSE <br /> I021 BERRYESSA ROAD U.S-EPA ID Number <br /> 33 <br /> 4td8-441-{3962 SAN JOSE CA 951 <br /> Faciti a Phone, CAW59494310 <br /> 9a. 9b.U.S.DOT Oescuption)including Proper Snipping Naha.Hazard Class.ID Number, 10.Containers HM and Pading Gmup{8 any)J 11.Total 12.Unit i3.WasG;Codes <br /> I NON-RCRA HFIZARLUUS WA51E 50L1LS, Na. DM <br /> Duanbty yyl,�. <br /> -F if]EBR18, PETROLEUM HYDROLARBoNB! � P 223 <br /> UJI <br /> (Dii ANA UtiDRkrr+cp'pi Fr et5� i <br /> USp -0rL � er¢s Ca►3tA.r,.ic-ust.0 art. <br /> 3. <br /> 4. <br /> 14.specal Handling Instructions and Additional lnlormaGon T5D:S.T 88Nf35&2?5 5113104? Lj : <br /> 2411 EMkRGENC`�i900-46$-1 T6d-CH/SK1 TFi-L"ontra�c�t`rete loco �O�O <br /> on initial trans orter to add nr substitute aw itional transporters onnfenerator'ers s behalf.? <br /> 15. GENERA,TDR'5fpFFEROq'S CEftnFtCAnpN:I hereby detlara that the contents of this consignment are fusty and axuralely descdbetl above dythe proper shipping name,and are Gassified;padaged, <br /> marked and labetedlplacarded.and are In all respects in proper condition for transport anooniing In applicable intemaficnaiand national ovemmenlal regulations.ff ex <br /> Exporter,I certify Mat Me ooments of Mrs consignment conform to the?sans of the altached EPAAcknowted gPort shipment and I am the Primary <br /> I certify that the waste minimizaben statement Identified M 40 CFR 21iZ27(a)(if I am a large quantity gment of Cons <br /> ty generaler)or(b)lit E am a small quantity generator)is true <br /> Genealor'IOffeWs Pdnted,T Name Signature <br /> on Day Year <br /> 6,Inlemation -pmenla <br /> ❑Import to U.S. ❑Eapad from U.S. Port of entrylexit_ <br /> Transporter signature(for exports only) Date leaving U.S <br /> 17.Tnansportar Admowledgment of Receipt of Materials <br /> 7 orter 1 PnntedFT N e Signatu <br /> CL Monts bay Yer <br /> to Tra rier 2 Phn yped Name Signature <br /> Month Day Year <br /> ~ C <br /> 18.Discrepancy <br /> 18a.Discrepancy Indlraban Space ❑Quantity ❑ <br /> TYPO ❑Residue ❑Aartral Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> IBd.Alternate Facility(or Ganerator) U.SEPAIDNurnber <br /> J_ <br /> LL Facti,Vf Phone' <br /> w 1-.Signature 0;Alternate Faality(or Generator) <br /> Month tray Year <br /> z <br /> ty 19.Hazardous <br /> '4uv1aste Repan Management Melhod Codes(re.,codes for hazardous waste treatment,disposal,and recycling syslems) <br /> O 1 1r i 1 21� 3. <br /> l 4. <br /> 20.Designaletl Facility Owner or Operator:Certification of receipt of hazardous matanals covered by the manifest exceptas ndsd in item i8a <br /> Priv dlTypad Name Signature <br /> 1 1 A � Menfh Day Year <br /> T1 ��7V3113a.PteiviaysJeipgn$l l��g ol�le. SIGNATED FACILITY TO EPA's e•MANIFES SYSTEM <br /> SO 1J1'7b1� �l )s�7�7 <br />