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w <br /> SSL s. $11k $HIP# 225028212 <br /> Form Approved.OMB No.2050-W39 <br /> Please print or type.(Form des Tied for use on elite(12-pitth)typewriter.) <br /> UNIFORMHAZARDOUS 1.GaneiaWrlDNumber 2.P 1oF 3.Emie rtcyResponsePhone d.ManRertTrecldng�Number SKS <br /> WASTE MANIFEST CAL0ee2262B5 1-80-468-1760 4 22 <br /> 5.Cerierelors Name and Mating Address Generator's Silo Address(U different than mai'ng address) <br /> Consolidated Container Co <br /> 75 W TRACY <br /> Rd <br /> YCA 95376-9129 <br /> Gene atoms Phone: 209-836-2151 U S.EPA b Numbe <br /> fi.Treris der t Carper Nenne T X 8 8000 8 1 205 <br /> 5RF�ETY-KLEYEN SYSTEMS INC <br /> U S.EPA ID Number <br /> 7.Transporter 2 Company Name MAD039322250 <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. <br /> Designated FadFty Name and Silo Address U.S.EPA 10 Number <br /> 8. <br /> CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD <br /> 488-441-0962 SAN JOSE , CA 95133 CAD059494310 <br /> Fade 's Phone: <br /> 96.U.S.DDT Description(ndudng Proper Shpping Name,Hazard Class.ID Number, 1 o.Cor marsqE <br /> 12 that 13.Waste Codes <br /> M end Packing GmW NanY)) No. WtNol. <br /> K X <br /> 0 . . ., 1 7 <br /> W "NW-RCRFrWTARD0O SOLIDS, <br /> 3NON RCRA HAZARDOUS WASTE SOLIDS DM P 223 <br /> (DEBRIS, PETROLEUM HYDROCARBON51i Z <br /> 4 <br /> 14.Special Narang IrsVu lions and Additional Information TSD:SJ 76285205 C099768 CSG.- <br /> w I)ERS0171g 1 'li�� )J flL� I <br /> 24 HR EMERGENCY Ni-B00-468-1760 ICH / SK / TFT) <br /> 15. GENERATOR'SIGFFEROR'S CERTIFICATION:I hereby declare that the contents d this co7sign—t are fully and accurately described vemaboby Iha PmPer s.if exp name,and are d I am the Packaged, <br /> marked and labeled/placarded,and are In al respects In Proper condition for bansport according to applMle intemabonal and national govermieNal regulations.if export shipment and I em the Pdmay <br /> Expoder.I wri that tha contents of hits consignment conform to the amus of the attached EPA Acknowledgment of Consent. <br /> I <br /> quanbty,g for)is wit. <br /> I oaUfy MN the waste mtnim¢ation statement identified in 40 CFR 262.27(a)(U rreratnr)I am a large quantity geor(b)(k I am a smaMonth Day Ylaar <br /> Ganeretal'yGRemrs Prlmsd7yped Name Ste`tura C3 3,0 <br /> 1. Shipments ❑Import to U.S. ❑Export from U.S. Pod of enhylexiL <br /> Date leaving U.S.: <br /> Z Transputer signature(fo(exports oMy): <br /> ua' 17.Traupalef Adcrowied9mem of Receipt of Materiels Morale Day Year <br /> ~Transporter t PnntedllYPad ... Signature (%.�, �7 ` U <br /> S r ,4 AJC X&I <br /> y SigmiaNre Month Day Year <br /> = rans Pdnied/fyped Nam n / 4' e 1 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Pa'Ual Rejection ❑Full Rejection - <br /> Manifest Reference Number <br /> ' LEPAIDr18b.Nlerriae Fadlxy(or Gerierabr) -Monet Day YearFacilxysPhoria:w18c.SignaWreofAft mateFacdityluGenerator) <br /> a 19.Hazardous Wast Management Method Codes(i.e., rdous waste irealment,dbposal,and recydng systems) <br /> 3. <br /> w 1 2. <br /> i <br /> 20.Designated Fadkhy Owner u operator.CaUfiraUon d receipt of hazardous meterlala covered by Ute marl tept as8a Ui <br /> �1 iii <br /> 'A Form 8700-22(Rev.305)Pre our editlors�obsojele. Z- DESIGNATED FACILITY TO GENE T R STAT E(IF REQUIRED) <br /> 3)7907771/1363089 <br /> -- - - <br />