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SSI. SK SHIP# 222201612 11111111111 111 111111 <br /> 005946916SKS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMD No.205MO9 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000226285 2.Pagy of 3.fnrgrpegay Rip —F4prte0 1.M *A Tr.&Jng Number <br /> WASTE MANIFEST 1 tL�PDDIIOO `Fbtl-1/b 1005946916 SKS <br /> 5,Generators Name and Mai dress AdGenerators Site Address(M different then maiirg ad r sa) <br /> Consolidated Container Co <br /> 75 W Valpice Rd <br /> TRACY CA 95376-9129 <br /> Generators Plane: 209-836-2151 <br /> 6,Tpr7y�poVf—1p,ndNahe SYSTEMS INC aU.S.EPA ID Number TXROOOM1205 <br /> 7.Traansspoorter2 rComppannyy NamU.S.EPA ID Number <br /> 8.Designated Facility Name and SM Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> FadNy's Phone: <br /> 9,. 9b.U.S.DOT Description(mdudN Proper Shipping Nang Hazard Class,®Number, 10.CC,,ta rs 11.Total 12.Unit 13.Waste Codas <br /> HM and Parking Group(y any)) No. Type Qualffty VA Vd. <br /> X 1 P —41214-6 3 <br /> — NDN RCRA HAZARDOUS WASTE SOLIDS DM P 223 <br /> (DEBRIS, PETROLEUM HYDROCARBONS) ,J r�� <br /> 3. —1 <br /> 4. <br /> 14.Speaal Handing IrsWdlors and Additional Information TSD:SJ 73538604 C099768 CS6: <br /> 1)ER611171 hblabs ZL14 <br /> I) HR EMEI�6ENCY Yl—B00-468-1760 (SK / TFI) <br /> AUTH AS 'AGENT—FOR" BY GEN TO RETAIN LICENSED SUB 641ERS AS NECESSARY <br /> 15. GENERATOR'SlOFFERORS CEATIFICATKIN: Iweby declare tlnal Uma nxderhts of tlhts mrsignmertl ore hilt' a telt'desamed above by the props shipping name,erd are dassfed,ped aged, <br /> marked and labab6rplatarded,and ore m al respects n proper oxnddm for transport aornrding fo appkede' and retinal govemmental regUabora.If export shipment and I am the Primary <br /> ExpaW I cesfy that nor contents of tits mnsgnmam conform In to leas d the attached EPAAck—Aedg of <br /> I car*that the waste mihln®tion slat~idenf6ed h 40 CFR 26Z27(a)(M 1 am a large quantity g )a(b) I am a smml q"bty generator)a he. <br /> Gahaatorsl s PdrdedTyped Mord, Day Yea <br /> aviibin� x 28 I7 <br /> 16.Intenu&NI Shornents ❑Import to U.S. ❑Export Nom U.S. Portof dmtrymxit <br /> Trarslnrler sign wm(for evons only): Date*ming U.S.: <br /> 17.TransportarActrnwladgmmid d Reoeipl of Maa®Is <br /> Transporter 1 PrirdedrTyped Nam Mordh Day Year <br /> y = ULL IJ `vl•�-�-� 28 <br /> zQ- Transporter 2 PnnWypgd Name _ SI Month Day Year <br /> 18.D'oaepency <br /> 18a.Discrepancy Indrauon Spxe ❑c).* ❑Type ❑Residue ❑Partial Rejection ❑Ful Re. <br /> Manliest Reference Number: <br /> 18b.Aflame Faclq(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Fedliy.Ph— <br /> W 18c.Signature of AMernate Facility(a Generator) Math Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes lor hazerdara waste heamhei,disposal,and recydhg systams) <br /> 1 20.Designated Facility Owma or Operator Certification of reoeipi of hazy doss materials covered byte manifest exoopt as nated in Mem l9a <br /> Printed/Typed NameSignaure Month Day Your <br /> EPA 7 22 Rev. ?r�'S 2� r'& 1363089 DESIGNATED FACILITY TO DESTINATION STATE(IF R(J�EbOyUIRED) <br />