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SK SFIIP# 221386299 111 IN 111111 oil IIIIII I IIIII <br /> 0058630048 K8 <br /> Please plint or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OM8 No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator Ip Number I,A(_000�262BS z.Pagel of 3 —FiI�tQ—l+ ,t rS 1 J(-,0 I.Wni(atT umber <br /> WASTE MANIFEST 0 0 5 8 6 3 m0 0 4 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(If QrRerenl fnen wading address) <br /> Cnnst-lidated Container Co <br /> 71� W 'J:1n:co Rd <br /> TF)AC'y' CA 95376-9129 <br /> Generator's Phone: 209-936--2151 <br /> 6.Tn?`' v"'ff' lR� SYSTEMS, INC. U.S.EPA ID Number TX R000081205 <br /> 7.Transporter 2 Company Name / ' U.S."Iber <br /> 8.Designated Facility Name and Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1.021 BERRYESSA ROAD <br /> SAN ,]OSE 9�13'_• <br /> 4018-441-096c CAD059494?10 <br /> FacililYs Phone: <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM end Packing Group(it any)) No. Type Quantity v,8,fvd. 13.Waste Codes <br /> X 1. NA3082, HAZARDOUS WASTE LIQUID, DM P DQ11 223 <br /> N.O.S. , (BENZENE), 91 P6 III 1 �j q a 5 <br /> W <br /> WX 2. RESIDUE LAST CONTAINED UN1479, DF f' `1c <br /> OXIDIZING SOLID, N.O.S. , (. ), 5. 1, PG <br /> zr <br /> 3-"ff#F&- *NON-RCRA HAZARDOUS WASTE, DF P 141 <br /> I. MI DS, (WASTE LIQUID), 5 5a� <br /> NUN RCRA HAZARDOUS WASTE SOLIDS DM P 223 <br /> (DFBP.IS, PETROLEUM HYDROCARBONS] 7 1 11400 <br /> 14.Spacial Harding instructions and Additbnal INomhation TSD:SJ 7PS35470 35470 C099 768 CSG; <br /> 1)FRG#171 .2)ERG#140• �� V <br /> 4 <br /> 24 HR EMEf�GENCY #1-600-468-1760 (SK / TF-I) �0'�,k3l <br /> RUTH AS "AGENT-F R" Y GEN T T q S - <br /> 15. GENERATOR'SIOFFEROR S CERTIFICATION: I hereby declare that fine coraenls of this consignment are fully and tety de#cribed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all res"in Proper condition for transport according to apphkable interne' 1 and I governmental regulations.ff export afwprneM and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the Iemas of the attached EPA Ac nowladgment of G int. <br /> I certify that the waste minimization statement identified in 40 CFR 26271(a)(M I em a large quantity generator)or(b)( 1 am a all quantity generator)is true. <br /> Generatoes,Teroes Pdntad/Typed Name Signature Day Year <br /> b4wl .bAoc Ol D 11 <br /> 16.Interna' nal Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. rt of enbylexit <br /> Transporter signature(forexports only): Dasa bavng U.S.: <br /> 11.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PdnhWyped Namesignain Month Day Year <br /> 4 ransporter 2 Pr int Name p,, ` Signature Month pay /Year <br /> ----7- <br /> 18.Discrepancy v 1 � ` <br /> 18a.Discrepancy Indication Space ❑ Quamtity Type ❑Residue <br /> Partial Refection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Akemate Facility(or Generator) U.S.EPA ID Number <br /> c.> <br /> LL Facility's Phone: <br /> H18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and rs7,.c4ng systems) <br /> 3 4. <br /> LP <br /> .Designated Facti V Owner or OpereWr.CertifrcaUon of receipt of hazardous materials covered a mandW in 8a <br /> m yped Na natu <br /> Month '�y Year <br /> EPgFpr ri3 ,e j,� .3 6 3)7907673 1 AVCg �}-}� <br /> Y ATION STATE tIF REQUIRED) <br />