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SSL SK SHIP#k 221751828 <br /> 0 0 3 9 4 7 7 1 7 S K 3 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000226285 2.Page11 of 3.fnalpgrt{y Rgspgpse X1 0 4.Manifest baking Nunber �� <br /> WASTE MANIFEST tltliit0111O0 4bBloo5947717 <br /> 5.Generator's Name ant Mailing Address Generabors Site Address(if different khan mailing address) <br /> Consolidated Container Co <br /> 75 W Valpico Rd <br /> TRACY CA 95376-9129 <br /> Generators Phone 209-836-2151 <br /> 6.T nETYC—VESYSTEMS, INC. U.S.EPA ID Number <br /> TXR000081205 <br /> 7.Transporter 2 company Name <br /> U.S.EPA ID Number <br /> f D S32- <br /> 8,Designated Facitity,Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> Facility's Phone. SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1 D.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> ac X 1. <br /> p Ar n .���... — 1 <br /> Q , , �ITiT! <br /> z 2. <br /> w 4E-P�--9RH <br /> � "l,—N 1- BSc <br /> 3. NON RCRA HAZARDOUS WASTE SOLIDS DM 7So P 223 <br /> (DEBRIS, PETROLEUM HYDROCARBONS] <br /> 4 <br /> 14.Special Handing 1ialructions and Additional Infunnation <br /> TSD-.SJ 72872722 C099768 CS6: <br /> 1)ERG#(:171• I <br /> 24 HR EMEf�GENCY #1AUTH AS �h800-468-1760 (SK / TFI) �,5 BY GEN TO RETAIN ITmNwn gig fiq 11 <br /> 1.1717 <br /> 15. GENERATOR'SIOfFEROWSCBWWICATION: I hereby declare that the contents of this consignment are hdlg�and accura desQibed above by the proper shclassified, <br /> marked and labeled/placarded,and are in al respects In proper condition for transport aocording to applicable inational nd natlahal governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmef Can 1. i <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(d I am a large quantity generator)or(b)(if a all quantity generator)is true. <br /> Generalors! s Pri t /Typed Name Signature Month Day Year <br /> nota ib; .� 103103117 <br /> 1 16.Inlemational Shipments <br /> I— ❑Import to U.S. ❑Export born U.S. ort of entrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PnntedlTyped Name <br /> CL u Signature Month Day Year <br /> WX <br /> D3 0� 1 <br /> Za ra r me S nature Month Day Year <br /> 1 -31 -71/7 <br /> 18.Discrepancy <br /> 1Ba.Discrepancy Indication Space ❑ <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejector <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number <br /> U.S.EPA ID Number <br /> v <br /> LL Faditys Phone: <br /> W 1ec.Signarlin of ate..—FadSty(or Generetor) <br /> 2 Month Day Year <br /> W 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste bealment,disposal,and recydng systems) <br /> 0 1 Z 3. <br /> 4. <br /> 20 Designated Faulity Owner or Opere Certificaton of I of hazardous materials covered by the manif <br /> P yped Na <br /> est except died in Ile 18a <br /> nt <br /> Signature MonQth Day Year <br /> EPA Fg870U2 Rev..40;Previous editions are obsolet ✓ 7 f <br /> 3)7907771 ED FACI TO TI A ION STATE(IF REQUIRE <br />