Laserfiche WebLink
SSL SK SHIP*~,-2 tTTT'45�M� IIIIIIIIIIIIIIII'�IIIIIIIIII'IIIIIIII <br /> 0 0 5 5 2 1 0 4 d. S K 5 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter. <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number2.Pag11 of 31Em8ry,iJtsa 4.Manifest Tracking Number <br /> WASTE MANIFEST (A(�)39-X1,3 a 1005521042 SKS <br /> 5 Generator's Name and Mailing Address Generators Site Address(a different than mailing address) <br /> crdn�r-Tri. gA <br /> kN�'4L <br /> SOMN TAS <br /> SZW�5er?_ kv�L41 <br /> GzacCR vvvi_ <br /> Phone: <br /> 6 a y"eSYSTEMS, INC. U.S.EPA ID Number TXR00008120,5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBURS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYE5SA ROAD <br /> SAN JOSE , CA 95133 <br /> 408-441-0962 CAD059494310 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WuVol. <br /> a223 <br /> o (OIL FILTERS) O� <br /> ag <br /> w <br /> z 2. <br /> w <br /> CO <br /> 3. <br /> _ I <br /> 4. <br /> I <br /> 14.Special Handling Instructions and Additional Information ISD.SJ *10ci(1 l -%A,5`�V5.�`.._p_ <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NJFi_'=SSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this oansignmeM are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and nal 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 EPA Acknowledgment of Co <br /> I ceftly that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) n am generator)is We. <br /> Generetot ` i's PnntedfTyped Nyne("� Signs Nre Month Day Year <br /> V Shipments <br /> -1 b$ ori 1 b <br /> —u 16.International Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. Portof enhy/ede <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Matermis <br /> ix T er 1 Pnntedrrypedy"le ) aNre <br /> a ( Month Day Year <br /> � <br /> Q Transporter 2 Printecifyped Name <br /> ature Month D� Year Day <br /> C <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Qwn. <br /> ay ❑Type 11 Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> W Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> zz <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for huardous waste treatinent,disposal,and recycling systems) <br /> D 1' 2 3. 4. <br /> 1 20.Designated Faality Owner or O :Certification of receipt of hazardous materials covered by the manifest except as noted in Ill 18a <br /> Pdnted/rype Name Sign Month Da Y ar <br /> lf <br /> EPff,/gt f7p��(F2elv,3zp5)P,ceviouseditionsa bsolete. DESIGNATED CIL( 70 DES (NATION STATE(IF REQUIRED) <br /> J �G <br />