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SSL SK SHIP# 225783262 <br /> Please print or type. (Form designed for use on elite (12-pilch) typewriter.) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS I ' . Generator ID Number 2. Page l of 3. Eme an Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL000299414 1 11 —468- 1760 011559111 FLE <br /> 5. Generalors Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> Chrisp Co <br /> 1001 Stokes Ave <br /> STOCKTON CA 95215-4023 <br /> Generators Phone: 209-948-3038 <br /> 6. Trrter 1 Com any Name U.S. EPA ID Number <br /> ETY—PLEEN SYSTEMS INC OTXR000081205 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC , MAD039322250 <br /> 8. Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S. EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> Faality's Phone: SAN JOSE , CA 95133 <br /> 408-441 -0962 CAD059494310 <br /> ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> HM and Packing Group (if any)) No. Type Quantity WtIvol. 13, Waste Codes <br /> NONE. NON RCRA HAZARDOUS WASTE SOLIDS , DM P 223 <br /> ( DEA I S , PETROLEUM DISTILLATES ) , IrFff� I .5 <br /> w <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> e <br /> 14. Special Handling Instructions and Additional information TSD : SJ 77005874 CH40434 CSS ; <br /> 24 HR EMERGENCY # 1 -800-468- 1760 ( CHAUTH AS <br /> n _ n BY QFN TO R— AIN NECESSARYSUBLCAfZRIERC <br /> A�q ....... <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this oorisignment arefully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I certify that the oontentsLU4opconsignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste statement identfiedin 4 62.27(a) (if I am a large quantity generator) or(b) (if Lam a small quantity generator) is we. <br /> GeneratorslOffeoff"Iryped Nameigna urerMonth ayear <br /> —r . Intern ens f-f <br /> ori > (03 <br /> f— LJImport to U 3. ❑ Export:from U.S Port of entrylexit: <br /> ' <br /> Z Transporter si nature for ex its onl : <br /> Dale leaving U.S.: <br /> W 17. Trans rterAcknowledgment ofReaeipfofMaterials a' ;, <br /> teTra po 1 PriotedrTypZY--- Ignature <br /> on ay Year <br /> p ! I l <br /> a <br /> Tran rt ' riot /Typed Name Signature r /M6nth Day Year <br /> 000 <br /> 18, Discrepancy <br /> 18a, Discrepancy' Indication Space quantity ❑ Type YP ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> � • <br /> V <br /> Q <br /> r'- Facilil 's Phone: <br /> w 18c. Signature ofAlternate Facility (or Generator) <br /> Q Month Day Year <br /> z <br /> N19. Hazardous Waste Report Management Method Codes (Le', codes for hazardous waste treatment, disposal, and recycling systems) <br /> 213. 4 <br /> 20. Designated Facility Owyr or Operator: Ce ificati f receipt of hazardous materials coy4ed by the manifest except ganatedrrin Item 18a <br /> Prime p Signafur Month Da Ye� <br /> &Z a%o Z!! �7 <br /> EPA Form 8793 Rev, 3-05) Previous editions are obsole DESIGNATED FACILITY TO DESTINATION STATE IF REQUIIRED <br /> 1 ) 7429310 / 731681 ( ) <br />