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�SL ck Slarp# �=° r�1^�,:rFk��;. IIIIIIIII#IIIIIfllllllllllll�llfl�l <br /> Please print or type. <br /> UNIFORM HAZARDOUS 1.Generaldr ID Number Q Q 6 4 5 2 1 d S S K 5 <br /> 2.Page 1 of & me R Form Approved,OMB No.2050 0039 <br /> WASTE MANIFEST CALi'tt1jE7?f]tJtF,'t..i t €_ ��`+_�sprzseP ` 4•Manifest Tracking Number <br /> 5.Generater's Name and Mailing Address ,l �((M <br /> T.r ij 1171 Generator's Site Address(if different than maifrng address} SKS <br /> ST nN <br /> Generators <br /> t�Phone: <br /> mp�n F1I2?l9—?43—'-1,j B <br /> SYSTEMS 1NC U.S.EPA ID Numbs <br /> 7.Transporter 2 Company Name TX r{� 15 <br /> �, <br /> C1_FAN HARBORS ENVIRONMENT L ro+VC IN u.S.EPAIDNumber <br /> B.Designated Facility Name and Site Address f. ?1AD0 a9 2i=50 <br /> i <br /> l.Et~N HARftARS SAN J1'SF 1 BFRRYF_§F4 ROP4D U.S.EPAID Number <br /> 4018-441-09.r-E SAN JOSE C:A �Si33 <br /> Facility's Phone: , ' <br /> 9a. gb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number <br /> HM and Packing Group litany))1. f0.Containers <br /> 11.iolal 12.Unit <br /> NON--RCRA HFI;ARDOUS WASTE Sir! - No. TYPe Onanvty Wt Nol. a.wasecodes <br /> kofl FILTER;) ' t13 PM <br /> z 2 <br /> 3 Fr <br /> 3. <br /> 4. <br /> 14.Special Handing Instructions and Additional Information <br /> T,r};v,_r t3t � j RY1c'c?1 <br /> is°4y; EtgF� F.rlr Vj$F,I�,. 4�,_17��17i-''-t . b" •R15fJ <br /> t' ti. +- - i. E.,TFI-•;;n�Tr� f ,�i�.r, 13;r a <br /> tr, ±r t,t �t .,t g r t'ntt rat spy S V� et y aFtr {r_,r-i <br /> 15. GENE and latS/OFFEROR'S CERTIFICATION I hereby declare that the contents of this coRsi9 manf are a Ify and accurately described above b the y <br /> z 1 +p, <br /> marked and labeledlplacaNed,and are in all respects in proper condition for transport according to applicable intemalionaland national governmental regulations Kexport ships and I am the Primary , <br /> Exports all Unity that the contents of this consignment conform to the farms of the attached EPAAcknowledgment r Consent. Y proper shipping name,and are classified,packaged, <br /> I certify that the wastes minimization statement identified in 40 CFR 262.27(a)(if I am a large quantile generator)nt of of se a small quantity generates)is true. <br /> GenemtorslOfiaror's Pnme"I Yped Name <br /> A Signature <br /> �',' FC %-'e, Month Day Year <br /> 16.Intemadonal SElhipments - "n 13 1 <br /> � Import to U.S. <br /> ? Transporter signature(for exports only,,: ❑Export from U,S, Port of entry/exit: <br /> L }7.TmnsporterAcknowiedgmenl of ReceiptWMatenals Date leaving U.S.: <br /> Tres 1 Ptried Name <br /> CL Signature <br /> Tr 2P to ICE— <br /> g Month Day Year <br /> ypdName�---F <br /> Signature / <br /> 4. fB.Discrepancy . <br /> Month Day Year <br /> E 18a.Discrepancy Indicatron Space <br /> ❑puanlity ❑Type ❑Residue <br /> . Partial Rejection ❑Full Rejection <br /> 18b.Nternate Facility(or Generator) Manifest Reference Nombec <br /> _J <br /> cA U.S.EPq ID Number <br /> w Facilitys Phone <br /> w 18c-Signature of Alternate Facility(or Generator) <br /> a <br /> ' z <br /> Month Day Year <br /> ILLI 19.Hazardous Waste Report Management Method Codes(i.e.,codes far hazardous waste heatment disposal,and recycling systems) <br /> O 1. <br /> 2. <br /> 3. <br /> 1 4. <br /> 20.Designated Facility Owner or Opera{or.Cedfication of receipt of hazardous materials covered by the manifest except sed-in Item 78a <br /> Printe Nam�!"�( <br /> � ignature <br /> EPA Form 8700-22(Rev.12-1--7))Previous editions are obsofete, Mon Da yes <br /> it?6i?+�0+„f156777 2 <br /> DESIGNATED FACT PA's O-MANIFEST SYSTEM <br />