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F lir 5K `,li P4 '-a4' <br /> lease print or type {" R EC� V E D 1 2019 . <br /> Form Approved,OMB No,2050.0039 <br /> UNIFORM HAZARDOUS i Genbra(orlD umger z 2, 1 oh'3 Em r se a 41,�M^1�anifestTraold Number V <br /> W 5 MANIFEST lJ d K <br /> 5.Genaralor s Name shot Matlmg Addles .,,generators Site Address If.dterentthan mailing address <br /> Cizca Air Sy t;eMS <br /> I t t ( d' g ) <br /> 214- 27th St <br /> S��f2tl!rliN'I'+�i • CA 9��31��--wG>�11I <br /> Generator's Phone: ' <br /> s,7 SYs;rSr<( '#UC U.&EPAIDNembar7.Trans orler 2 Company Name <br /> TXR C9 t �l A <br /> r U.S.EPA ID Number <br /> ENvIRcirilltNTA�. SVC rrlc. - ;�w��f <br /> 8:Designalod Facility Name and SileAddress C.FAN Hf2EitlRS 91N �7b3St U.S.EPAID Number <br /> 1021 SERRYESSA ROAD <br /> i A, N JOSE , Cly 95183 <br /> Facility's Phone: <br /> go. 9b.U.&DOT Description(including Proper Ship ing Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WI:Aloi. 13,Waste Codes <br /> �OEC>Ii -THYLCYCLC�' KITI�SL6,X <br /> T �NE; <br /> Cl l'IOUSTYBLE L 10ti <br /> 2. <br /> LUi <br /> 3. }i <br /> , <br /> 4, i <br /> 14.Special Handling Instructions and Additional infof V. ;nTS)} S <br /> •1 r <br /> 7 <br /> 1)ERMP.80 1 dd1 1 <br /> �tii Cltllft7Nt `�# 4�t ---468-17'tb-CHISIiI'lt�l�laontrart r-efi:air, 'generator enfr atrty .au'lhirl^z k <br /> ..on initial ;Han ar ars t add or .tsubs�c��rt�;. ad iiia'Aa t qrs±�lar�to°rrys nt1 UOrter�zftYr�py behalf. <br /> 45. GENERATOR'SIOFFEROR'S CERTIFICATION l h reby declare that the contents ot:this consignment awfully and accurately described above by the.proper shipping name;and are rlasslfied,packaged, <br /> marked and iabeled(piacarded,and are in.all respect In proper condition for transport according to applicable internationaland.nationai governmental regulations.If export shipment and lam the Primary <br /> Exporter,i certify that the rintenls of this consign a 7 tconform to the terms of the attached EPAAcknoMedgmentof Consent. <br /> I certify that the waste minimization statement Id inlifiqd in 40 CFR 262:27(a)(ifs am a large quantity genera)q)or(b)(iii am a small quaiillh';generator)is true, <br /> enera sl eror' rinied/Typed t <br /> t 16'in Da e <br /> 'Jk in: <br /> _j 18.lnternalronal Shipments ❑ (� 'Import to U S t_t Exporl from U' Port of antrylexit <br /> Transporter signature for ez oris only):p° 0 ( p Y)' f'°. Dale leaving U.S.,, <br /> W 17.TransporterAeknowiedgment of Receipt of hdaledal W > <br /> Transpo hid dfTyped Name signal ur — Month Day Year <br /> � Tr r2PTsd Name <br /> a Month bay Yea <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Sp <br /> ac t� <br /> t_.f Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Fuil Rejection, <br /> Manifost Reference Number! <br /> I 8b;Alternate Facility(or Generator) <br /> UIS;EPA ID Number <br /> ZI <br /> U � <br /> k Facility's Phone: I <br /> w 18c,Signature of Aiternale Facility(or Generator) Monih Day Year <br /> d <br /> t0.Hazardous Waste Report Manage, 6t Ihpd Cod s{t. „codes forhazardous waste.trealmont,disposal,and recycling systems)i <br /> 14, <br /> 20,Designated Faci1W Owner or Operator:Crificatlon if recei Fltazardous mater ais:covere y the manifest er peas note)in II a <br /> Pit to 1Td m <br /> 5lgn n r y Y <br /> EPA Forni 00.22 ev i2.7 revious editions art.obs1 etc. Z�Y�nO§LIGGZNA*fi�Pn fiAC1LITY 10 GENERATOR <br /> �)} z'r ISS% <br />