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I <br />Nbe. (Form desial'I'd for used <br />writer) <br />Form Approved. OMB MP.2050-0039 <br />HAZARDOUS "-Ce <br />VRIU% 5 5 6 <br />ONAJSRTM6..MANfPESL <br />2. Peg e."f-I <br />p pm.6 tfest'craciangnimater. <br />wedpok.. Man <br />.. .. <br />7 <br />008483834, dJK <br />address) <br />100REED STREET 2222 S. SIWLAIR AVENUE <br />AANTACLARA CA 85450 STOMON CA 95216 <br />t;eneratces Phone. 0,, 7-s , .4 47 3804 <br />p:..1V Dk <br />M04M'SERVICES INC; TRANS.""'.9W ".WO 0 1 1 0 1.7 <br />.-1 <br />U.S.dE <br />7. Tra nspoder2 compa ny Nerne, AID mb at <br />ENV ENVIRONMENTAL INTERNATIONAL A R-0 0 0 1 7 9 3 8 <br />dAddress <br />Hwy iZ I IMi 9 O�.'QY 16 ACRES. <br />BEATV:NV 89003, <br />' <br />-T330 0,.0 0 00 <br />Pacifit/sphone: 778 . 663-120 N .V 4 <br />So., <br />9b. u.S.'OOT Dasc,tip'66 OnducH <br />10. contadnem. <br />Il . Jobd <br />u. uni <br />13. Waste Codes <br />No <br />T <br />HM, <br />Rd Ps <br />Quantity <br />1. NON -RCRA'HA_@Dous WASTE, SOLID (OILY z4 -DEBRIS, <br />:221 <br />o <br />_ <br />ABSORBENT)' <br />goo <br />p <br />z <br />2. <br />4. <br />14..Spoda[Ha.ri4linginstucdonsa,ndAddftnallafonaUon UWS EKW71 - <br />0;3DI Z$3040` 2- <br />1 Zig _$W BE OMIWXQD AND USE FM <br />L)M. UANDW <br />15. GENERATOR'SIQFFEROFUSCERTIFICATlON: I hereby declare thatthe contents of this =sIqueent are fitly and acwriftely described above by the pppershipiolng new, and we cias O,ffed, padmiled, <br />ma(Ad and labelelpfacaMed, and are 1"11 respects In proper condition for tans* soconding to applicable Intarnationaland national governmental regulations. if 6" shIpmenlarrid I am the Primary <br />mignmentconfumn in tb termsof the attached EIRMoknowledgment of Consent <br />I cartily that the waste nnIn1mIza6R Blatementidandilied In 40 CFR 262.27(a) tf I am a large ittrantity generatot) a (b) (II am as quantity generalor) Is We. <br />Gene MsfolleivsPrinte edN Month Day Year 7.. <br />Y f4 <br />t6.fintemational,91hipmends <br />9 <br />from U.& of entryke <br />❑0 inqp6it to U.S. E]Ewrt pc� <br />Transporter signAre (kr exports an]# 'bate lewing US.[ <br />117.1ransiparter*&Aeltimenlof Re6alpt ormaterfas <br />Trans orter Pm'tOwTY?M 8111mawns Momn Day Year <br />0 <br />MbAtky &/ <br />Transporle.rMnte ypedNanne Signature Month Day Yw,-? <br />1A <br />ISO. Discrepancy Indication Spaos El Q"w Ehype F1 Realch, El Partial F4.clho�n 11FUIRkedder <br />ManIfest Reference Number. <br />Ift Alternate Facility (or GanemOx) U.S. EPA ID thantoor <br />URI <br />Facility!s Phone; <br />Ift Signature ofAlernate FacIlity (or Generator) <br />Month Day Year <br />19, HmnlovsWaste Report ManatierrientMethod Codes o.e., cedes for hiurardous waste treatment, disposal, and reoing system) <br />2. 3. <br />4. <br />20.DesighatidFacU,tyOwnerorOpemtmOeOmWofraWpt6fhmrdmma*rlatsmvem byMema at except as rioted In Item I Be <br />"nature N Year <br />DESIGNATED FACILITY'S.", 0 <br />