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-- \/ 17065106�j <br /> Please print or type. (Form designed for use on elite (12-pith) typewdler.) Form Approved. OMB No. 20504)039 <br /> UNIFORMRAZARDOUS 1. UenealnrIONumber 2Page or 3. Ememenry Response Phone 4. ManbestTmcemumber <br /> WASTE MANIFEST CAD014063SBO 800A33-8253 QQ Q 1 N 9 6 7 3 DAT <br /> . G <br /> Name arm Marling Address ATTN: GnryKrebbs ne,aara sne.aaress ladmom,d Ban mar,g aadass) <br /> Trs m Unifasd School DistrictGeTragHigh SGhoal <br /> 1875 WLoweY .4'a 315E t1 Ith St <br /> Tracy, CA Tracy, CA 85376 <br /> Genramwesphow 209-321-3429 <br /> e. Trensponer 1 Company Nameus W Neml»r <br /> Ingaraium (Sacramento)r"ERIPHONE-CustlDE876"DG4`• CARDW179747 <br /> Tran podar2 <br /> p <br /> Co arry Nana <br /> murder <br /> 1i ) I r2 r � e? ✓zr D 49>- '2- 7W 3 <br /> B. Deggnaled Famiy Name and SneAddass U.S. EPA ID Number <br /> Clean Harbors San Jose, LLC CAD059404310 <br /> 1021 Senyaase Road <br /> San Jasa, CADS133 <br /> FaanHs Power: 44M8-441-0962 <br /> be 9b. U.S. DOT Des,.apinn (mfaLp Pm Seeming Name, Hazard Class, ID Number, Tobi 12, Unit <br /> HM Parkn9 Group(if a.ry)) ase dhy ouafasleCWes <br /> 1'UN1780, Wada Canosiw liquids, nms. (aft a , hydrochloric add), DD02 D005 D <br /> 011 <br /> x 8 , 11 <br /> CP O OF eaod L F003 792 <br /> �NA3D77, Hamrdous wash, solid, nes. (silver, acetone), 9 , t6 D005 D011 FOW <br /> X <br /> 352 <br /> 4. <br /> 14, apechdl Handling Insructume asmAdMaren Info,maaon <br /> - Document D52755 Sales Order 77982 <br /> 1)ProJffO=H818279 DOTFRG#Ir4 i z<r!Cs (.+A) <br /> 2)FaaeMO#CH818286 DOTERGIV171 ( t(- r ) (k t: <br /> 15. GENERATOR'SIOFFEROWSCERFIFICAnON: I hereby declare mel me contents of Mis consignment are fly and aovrawly deunbad above by lire prefer shippf9 name, scare aaalbed, packaged, <br /> marked! and Ieb&ea/plawNed, and mama ab respects In goper mndNon he appVcable InlemaVonatarA nabonalgovemmoMai ngulabons Bexpal sapmenland I am tlw Primary <br /> Expodor ce,uy ma IanE 01016 bme telcos olmea9eN� FPAAtlmowbtlgmanlol CansonL <br /> anVY mal me vraste mnb,lizaVon taWamHed 'n40CFR26227(a) (alamoJwpquanby Venemtor) or(b (XlamaemailquanBtyganeabr) is We. <br /> Gena dlwNOrtemfa Probes yped Name slp�ahm Montsry Oay , <br /> lar <br /> F 16. <br /> Insennatcaff ShIpmems ❑ Imleonbu.s. ❑ Expert ham U.S, parlerfamiryleak <br /> Tmrspofrersl9naBae (fix oxpods only): ale lervLg U.S_ <br /> w 17, farspodaAtlavMed9mem apere orRereiplofMa ais <br /> nsder 1 Ferrari IWUI Name SlgnsfDay <br /> fi caa ( i , <br /> DO <br /> Trsnzparmr2 'nieNryped Name MOnm Day Year <br /> 2 zz <br /> } 10. 06aepanq al , on <br /> IFI 18a. Oizcayamy lnmceban spar ❑ Daanuy ❑Type ❑ Residue El Partial ❑ Fun Rejection <br /> Manama Reference Number. <br /> lab.Nlemma Fadrly(or crewmen) U.S. EPA lO Number <br /> La <br /> aahNs Phone: <br /> 18e SI9naure olAllemale Fao'liy (or Geneatuo klonih Day Year <br /> CD <br /> 19. Nazamppa Ware epod Man gement Motlwd Codas U.e., abrM1a7aMous weals hvaMenL d1spcoai, aM recych9syslams) <br /> c L <br /> ID. DeslgneNdF nor Opea . Cer9n of receipt of M1amNous malaials mvn iby Ne manBulex ndmnllem tBa <br /> PnnteMw Ne Signa ITS a <br /> EPA Foan 8700-22 (Rev. 5) PrrAoA editions are obsmae. - D L4AT FACT LITY TO DESTI NATI ON STATE (IF R EO UIRED) <br />