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sic SNIP# ?2329SOZY <br /> Please print or type.(Farm designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0439 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 2.Pagg 3 of 3 E ergency Response Phone. 4,Manifest Tracking Number <br /> CA �a 1-1 006144660 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and MaiFing Address Generator's Site Address(if different than mailing address) <br /> 31 Tt'an ; ,0�, lU Giu <br /> =00S Krohn Rd <br /> FRACY CA 95377--94.20 <br /> pn35w6779 <br /> Generators Phone: <br /> 6.Transport ICompanyName '•YSTEMS INC U.S.EPA 10 Number TXR00002) <br /> 7.Transporter 2 Company Nama U.S.EPA ID Number <br /> VA <br /> B.Designated Facility Name and Site Address THERM FLU11)8 U.S.EPA ID Number <br /> 123533 SE CARPIENTER DR <br /> CLACK�i11A" <br /> OR 97015-8980 <br /> 5�?3 785~4c5 b DR00000251" <br /> FacRy's Phone: <br /> ga 9b.U.S.DOT Descrpbon(nduding Proper Shipping Name,Hazard Class,1D Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nal. <br /> - <br /> o t r:t,irl�U, uhi ; t t�lEii USLv UiL <br /> W <br /> LU <br /> 2. <br /> 3. <br /> 14.SpedalHandling lnsirtutionsandAddTronallnformation TSO: TPP 7�4f46573 CA47950 20I73r8 C;Srf- L4 <br /> :Z4 8R EMERGENCY #1-800-468µ1764 (SK t TFI) � f <br /> AS "AGENT—FDR" BY GEN TO RETAIN LICENSED SUB CARRIERS A8 NE -`"EB,t�R <br /> 15. GENE and la SIOFFlacard d CERTIFICATION:ndareallre !hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledrplhe COnt,and are in all respects in proper condih'on for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> E�wfer,I certify that the contents Of this consignment conform C 10 the terms of the attadied EPA Acknowledgment of Consent. <br /> t certify that the waste minim nation statement identified in 40 CFR 282.27(a)(if I am a large quantity generator)or(b)(if l am a small uant <br /> Generator' Priatedlfyped Name 4 ly generator)is true. <br /> Signature i <br /> ;' Month Day Year <br /> 16.International Shipments Y <br /> '1 1 <br /> Transporter s gnature(forexpods only❑import to U.S. ❑Export Pram U. Port of U -2 U entrylexit: <br /> U.1 17-1 ranspnrterAckrrvWw1—tott{—kmaterials DatefeavngU.S.: <br /> Transperter 1 PrinfedlfypoName <br /> Signature <br /> w �-1'` I' ,� , Month Day Year <br /> Ttanspo '2 Pd itedlTyped Name } { ,L! <br /> nry Month Day Year <br /> 18.✓jisuepa <br /> 184,Discrepancy indigtion Space <br /> ❑ Quantity ❑TYpe <br /> ❑Residue ❑Partial Rejection <br /> ❑Full Rejection <br /> 18b.AJtemate FacilityGenerator) Manifest Reference Number. <br /> Q U.S.EPA 1D Number <br /> Facilil)/s Phone: <br /> LU18c.Signature of Altemate Faal!y(or Generator} <br /> Q <br /> Z <br /> w1g.Hazardous Waste Report Management Method 4 Month Day Year <br /> 1 Codes(i.e.,codes for hazardous <br /> 2. waste treatment,disposal,and recycling systems) <br /> 4 <br /> 3. <br /> 4. <br /> 20.Designated e ty Owr er or Op rafor:Ce im <br /> Printed7eNamarae cation DI receipt of hazardous materials covered by the manifest except as noled in Item 18a <br /> ypd <br /> r j Signature <br /> EPA Form8700- J �" ; <br /> b( a J?evrauSed itions ar�ohsolete. Day yea <br /> f rK. <br /> DESIGNATED FACUT <br /> GENERA R <br />