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CIS OIL -BH!P4 ' ur3nen erre+n. hme lCerv.: deeinnerl#nr cies nn elifn 114-nilrhl hrnauriforl Form Annreved. OMB No. 2050-0039 i:+%f83:�`,Jrr[ t1i/J;✓ fr `x.. Ali Vj UNIFORM HAZAttDOli5 1. Generator ID. Number . z )iJ s � � s f ' 2. Paga of f .Erne y R po a Pfrone, 4. ManifestTrackin Numher , — «sf�f OR SKS WASTE MANIFEST 5. Generators Name and Malting Address ■ Generator's Site Address (if different than mailing address) 00 W )'(7. Y?)"Iway 12 pp14r�4`YY:4 Ij4 0-15242-0000 GenerattoesePhone; op nti,l';j~'c�'83-1.569 6.T ffrp r `t mlar y t.€�E YST-EMB INC U.S. EPA ID Number TXR000081205 T-fraLnsLp. orter t2 CompaRNamU.S. EPAID Number HARBORS EN01RONENTL aisINN. AL0:93 Y 225 8. Designated FacilityName and Site Address }{ (� �jj ��.jrjr� r g��} r „ —�... U.S. EPA ID Number g FT.�.��I� ��l'IE.•M.ii 5lsk t]! LI�� 411.1 ifs„ MJ BFFqRYV8SA ROAD SPIN JOSE CA 95133 MD0594 74310 Facility's Phone: 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11. Toast 1Z. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity W VOI. 1, NON KRA HPIZARK1116 TASTE 90LADS 2 Z su 2. 3. 4, 14. Special Handling Instructions and Additional Informatmn;# ni34�a Tit 1 5/.1, ti_{� Ft 1 F .? F~S�t1:,''f ? f �tl' r a w :� ..o F1f � 4t iF' -�:t rt'8; i � rr s lJV get.i ra r�r'' to n f r` �((� tenet a�m�t��ar ranr initial '�'f ati':4 •if�1�°�rer to .arid or :;ubsti�;ut& arjditj.cfrt .� � an�;#:3c ^ter G i 09.VkMr a%estel s behalf. 15. GENERATOR`SlOFFEROR'5 CERTIFICATION: I hereby declare that the contents of this consignment are folly and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable irrtemationatand national governmental regulations. tf export shipment and I am the Primary Exporter, I cartify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent, I cartify that the waste minimization statement identified in 40 GFR 262.27(a) (f I am a large quantity generator) or (b) (if I am a small quantify generator) is true, Generatues`/ONerarj's Prtntedrryped Naam�e� Signature Month Year S /bay / /� �1r n �i f M..-. !/L Y 1 -14 16. fnte "ational Shipments . ❑ Import to U.S. ❑ Expert from U.S. Part of enwexit: Transporter signature (for expodsonly) : Date leaving U.S.: 17. Tmnsports rAcknowledgment of Receipt of Materials Tr9ns rterI PrinteppedName Signature Month D� yy Year �f �t�hf CL y f} y j] 19 err k9 'Wt:n.+...'. ..R...r .' .�u�s N'.•M.`�++ �MJ _ aTranspo �Y P 'ntedlTyped Name ' Signatures a Month Day Year 18. Discrepancy 18a. Discrepancy indication Space 0 0uantRy ❑Type ❑Residue ❑ Partial Rejection � Full Rejection Manifest Reference Number: 18b.Alternate Facility (or Generator) U.S. EPA ID Number U Lar.. FacilitysPhone: 18c. Signature ofAfternate Facility (or Generator) Month Day Year a 19. Hazardous Wasle Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) .- UJI a ,J 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest excepts noted in•IfemlBa Printedfryped Name_ / Signature �` �;^�� Month Day Year }�1 �^'.t'"`I �-'"":vQ.,xf.�� A' �•� .tI.��''�.�� est+ 'p.. �`�f!/'ri. �i�n .,....-e:..e tfiF-,f�YJ':'�' �'\X' 1 �� EPA Form 899997040.22 (Rev. 3-051 Previouseditionsare obto(ete. ff Z rme-allh- A ED ACIIISWIM GENERATOR i:+%f83:�`,Jrr[ t1i/J;✓ fr `x.. Ali Vj