Laserfiche WebLink
0 0 5 3 2 9 9 0 4 S K S <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 T.; _ __- 2.Page 1 of 3 Emergency Respwse Phone- 4.Manifest Tracking Number /� SKS(� <br /> WASTE MANIFEST 0 0 5 3 2 9 9 0 4 S K S <br /> 5,Generators Name and Mailing Addle ss_ Generators Site Address(if different than mailing address) <br /> SRLIDA CA 95368 <br /> SALTDA <br /> Generator's Phone: ''7��--�T'�1' 7 <br /> 6.Transporter 1.Company.Name ,NC U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address ----EN OF r U.S.EPA ID Number <br /> i-f AVE, <br /> NEWARK: , CA 945E0 <br /> 510-795-4400 CAD980887418 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waft Codes <br /> HM and Packing Group if any)) No. Type Quantity Wt.Nu1. <br /> 1 <br /> O <br /> z 2. <br /> Ulu <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information SAL <br /> mENSED SUP CARRTERS AS NECE <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and Iaheledlplacanded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I dandify that the contents of this consignment conform to the terns of Use attached EPA Acknowledgment of " <br /> n <br /> I identify that the waste minimization statement identified in 40 CFR 262.27(a)(g I am a large quantity generemr)or(b)(' a a small quantity generator)is We. <br /> Generator erors rntedlTyped Name Signature Monde Day Year <br /> 0l3 Let <br /> b <br /> j 16.International Shipments <br /> i <br /> ElImportto U.S. ElationfromU.S. Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,TransporterAcknaMedgment of Receipt of Materials <br /> Tnsport 1 Printed/Typed Name Signature Monts Day Year <br /> CL rac,7- a$ Z�C <br /> Transporter 2 Printetl/Typed Name Signature Month Day Year <br /> K <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Spare ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Z <br /> 55 19.Hazy Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1 �` 2. 3. 4. <br /> Facility O .Ce tion of receipt of hazardws materials covered by the m - t as <br /> Hai Je ed N!PW Signature Month Day <br /> Year <br /> C ti/ _. -. !ice- �� 0 z <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />