Laserfiche WebLink
SK SHIP# 2x6375037 <br /> SSL po635� 16S166k5 <br /> 'Approved.OMB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 4.Manifest Trackin Number �/ <br /> 1.Generator ID Number CAL000427958 2.Paga]of 3.EmerAeAGitRe gorl5e PtiogB. O O 6 3 16 06 SKS <br /> UNIFORM HAZARDOUS 1 11 66�OYY!! GGttlS 1 <br /> WASTE MANIFEST GeneGo—r—jSite Address(if different than mailing address) <br /> GeR&BSInteroe alress <br /> 1000E Roth Road CA 95231-0000 <br /> FRENCH CAMP <br /> 562-822-1234 U.S.EPA ID Number <br /> Generator's Phone: TXR0�D00B1205 <br /> 6.TrtrW�LYSYSTEMS INC <br /> U.S.EPAID Number <br /> MAD039322250 <br /> T Trans rler 2 m n Na <br /> LEANCo} { me <br /> BO ENVIRONMENTAL SVC INC. U.S.EPA IDNumher <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE <br /> 1021 BERRYESSA ROAD } CA 95133 <br /> SAN JOSE CAD059494310 <br /> 408-441-0962 <br /> Facility's Phone' 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Nurn No Type Quantity vill <br /> HM and Packing Group(H any)) DM P '2'23 E <br /> NtlN RC RA HAZARDOUS WASTE SOLIDS 3 � � <br /> o tDEBRIS, UM HYDROCARBONS <br /> PETROLE <br /> L, 2 <br /> our <br /> U f <br /> • t 3 <br /> r <br /> TSD:SJ CSO: <br /> 14.Special Handling fnsauctiorrs and Additional Information 77A14554 PB120fi <br /> 76m-CH/SK/TFIute additional retained by generator confers agenvy authori y <br /> 24N EMERGENCY#800-468-1add Or substitdditional trans orters on enerator's behalf. <br /> on initial trans arter 76 ,isllyaccurately <br /> 15 marked anM'SIUI;P acUKe and alre in all lOrespeclsr nbProperacondition for transport acro d nggo applicableuinie atiocal and nal ongo governmental regulaGons.rf export shipmenland I am the primaryed. <br /> Exporter,I ceml that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent,am a small quantity generator)is true I ceNfy that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or ( Month Day Year <br /> _ Signature p t] [ <br /> Genemtofs101rerors Pri y d Name <br /> 16.International Shipments El ImpoA to U.S. ❑Export from Port leavingof S . <br /> Date leaving U.S.: <br /> z <br /> Transporter signature(for exports only): <br /> W 17 Transporter Acknowledgment of Receipt of Materials - Month Day Year <br /> Signature <br /> C)6 (R' <br /> Transporter 1 PrntedlTyped Ni <br /> O .9�p}{guGe—7`Vi <br /> Month Day Year <br /> d Signature <br /> QTransporter 2 PdnledTyped Name <br /> lY <br /> r <br /> 18.Discrepancy ❑full Rejection <br /> Tye ❑Residue ❑Padiat Rejection <br /> 16x,Discrepancy Indication Space El Quantity <br /> Manifest Reference Number. <br /> U.S.EPA iD Number <br /> 16b.Alternate Facility(or Generator) <br /> J <br /> U <br /> rat Phone:Fadlity's Month Day Year <br /> 18C.Signature ofAltemate Facility(or Generator) <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(te.,codes fior hazardous waste treatment,disposal,and recycling systems) 4 <br /> W t 2. <br /> 0 <br /> Signature Month Day Year <br /> 20.Designated Facility Own—a r Operator Cedifiration of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedlryped Name <br /> EP Fo 87 ev.3 Q Pr v us editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> A1)�127���114�84�� <br />