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f1` tel=lti SK N P4 28'7 1 439015 <br /> J. <br /> Please print or(jpe. V R c- im fB 0 2019' <br /> UNIFORM HAZARDOUS 1,Generator ID Aunt er Ag I of , mer oncy Form Approved.OMB No.2050-0039 <br /> R e9f heone 4.Manifest Number <br /> WASTE MANIFEST Y7h sJ of— <br /> 5. 523 SKS <br /> —Generator's Name andliallingmd—ress <br /> enerator'$Site Address(if different.Ih Drimallingoddross) <br /> Cisco Air By!:-tPM5 I flic <br /> 2f4 27th St <br /> Generalor's Phone: 91G-444-25' 5 <br /> 'IRPOE'�FMOORO P U,S.EPA ID Number <br /> 7.Transporter 2 Company.Name i r w~ U.S.EP It <br /> \Z-0� )Number <br /> TUesIgnated Facility Name and Site Address CLEAN HARBORS SPIN JOBE U.S..EPA ID Number <br /> 1'121 8,ERRYE,138A ROAD <br /> 88N JOSE <br /> 8- 09 <br /> Facility's Phone: 40 441— 68 CAMB3949431 0 <br /> go, 9b.U.&DOTDoscription(including Props Shl Ing Name,Hazard Class,10 Number, 10.Containers <br /> HM and Packing Group(it any)) 11.Total 12.Unit Q,Waste Codes <br /> 1 1 1 — NO. Type Quantity WLNOI. <br /> �4*#V-. NON RCRA H B WASTE SOLIDS <br /> It DM P <br /> 0 PENOLE F OCARBONIS) WA' <br /> YDR <br /> Z 2. 10 <br /> W <br /> 4. <br /> 14.SpecialHandling Instructions and Additional Infor aeon , <br /> TSD IEJ -1813640.98 V,1 337'p' c8B.- <br /> 7q <br /> 2,41-1 r-MEROMCM00-468—U7 0—CH/SK/,rFI—Contract retained <br /> goneratoy, Qunfferrs 'a 41 ,. <br /> withority <br /> tin irlit I A it,I Zl A fq ri'A r.I I t,+i t I if 11 'A fis I i 4:i n +-;4n qn ti v�+a%•,m K" n a n cl I-A A-,t w knkm I f <br /> 15. GENERATORISIOFFE�RS�. CPPRT'rl'FPI(C�AiTION I h reby do <br /> date that the contents of this consignment are fully and accurately described'above by the rproper ihipoitig name,ard,are classilled.pack <br /> eq. In proper'condulon for transpot(according to applicable International and national governmental regulations.If export shipmeni ands am the Primary <br /> marked and labelediplacarded,and are In all res aged, <br /> Exporter,f tertily that tile contents of this consig i <br /> conform to die terms of the attached EPAAcknowledg tent of Conso 1. <br /> -.1-certify that Ill <br /> e waster minimizalionstattoment}d Mifi in-40 CFR <br /> anutygenerat r(b)'(11`1 M '$Mau <br /> t d[Typed Na sliInat <br /> r6jer or 101foror's Pirm e Monti) Day Year <br /> -j 16.htemagonal Shipments <br /> DImport loul El <br /> S. Export from U.S/ ori ofenlrylexil., <br /> 9 Transporter signature(for exports only); f j5` ,Oat9 leaving U.S,,, <br /> W 17,Trarspoarklinowledgmeni of Receipt of Majorlal <br /> t� Transilp06-171'rinted/Typed Name Si nal <br /> Z- <br /> 0 Month Day Year <br /> CL <br /> Z g Tan Pfinte/Typed Name Tran <br /> " Si u Month I Yo at <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> El "niftyp e ❑ <br /> Residue ❑Partial Rejection El Full Rejecfon <br /> Manifest Reference Number: <br /> 18b.AIjqrnato Facility(or Generator) U.S.EPA 10 Number <br /> Facility's Phone: <br /> LL1 18c.Signature of Alternate Facility(or Generator) <br /> Month Day ear <br /> Z <br /> V— 19.Hazardous tkastoR <br /> epor[Managemonl-Mal,hod Cods(i, codes for hazardous waste treatment,disposal,androcycling systems) <br /> 2. <br /> 20.Designated Facility Owqbr or.CriloratocCeflificaugn(f re 1ptottgoAus malorials,covered b,09 manifest OAV�s n-dqVil,lialrya <br /> T11—nied/Typ "o" Si r Mon, Do Yep <br /> EPA Form 8700-22(Rev.12-17�. Previous editions at I a OT610. Z-fIES16NATED FACILITY TO GENERATOR <br />