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SK HliP4 <br /> Pleas©fyinf or type, 1:Generator iD N rube CA�V�• 1 ? J O 2.Page,�1 of 3.1Em e)r�ry R{s oJlsa 1hYG6 4.Man es Tra I <br /> Form Approved,Otvie No.2050 0038 <br /> r it tS !G SKS C.dFOf2M KA ARDOUS 1 ' j a41 b6 2 S i\S <br /> WASTE MANIFEST 8 <br /> 5.Generator's Name and Mailing'Address I nerator`s Site Address(if different Ilion mailing addnibi;) <br /> Cisco Pliv Systems Is e <br /> 2A4 27th Ot BACH ENT O <br /> art CN 95816-32012M <br /> RECEIVED ��� <br /> Generator's Phone: a4�1+ <br /> 6.7ryi4t"kr ��nt Lt�f`t< <br /> SYSTEME INc U,S,EPA IDNumber Xri( +7l +a� '4y1�t <br /> 7.Transporter 2 Comany.Name US.EPA ID Number <br /> U.E AN t�l�N AUR a I;NVIR' Vii "N'!Fl[_ SVC INC. <br /> 8.Designated Facility Name and Site Address %—E AN HARBORS BAN JOSE, U.S.EPA 11)Number <br /> 1 wi EERRYE:SEA trllAD <br /> e'"N i.0's(:. ry Cit 9513,3 <br /> Facility's Phone: <br /> go, 9b.U.S,DOT Description(including Proper Ship Ing Name,Hazard Class,ID Number, 1D.Conte hers 11,Total 12,Unit 13,WasteCodes <br /> Hti{ and Packing Group(if any)) <br /> No. Typa Quantity WtrVOi. <br /> 1 #{: <br /> NON o tl k:kl tIa, C � s ? <br /> j � 3Y �3 �LUi4 <br /> PEEL <br /> P11YMCARB!,M3, W'1#1 <br /> 2. <br /> w <br /> CT <br /> 4. <br /> TA.Special Handling Instructions and Additional nro talion t f p 3• <br /> A 9 � T�IJ.ZG',tei '��13.�.:�� C1 33793 <br /> 244 retained by gonr ator c;c�r>fU' s A ancy altisi.alrii y <br /> tin initial trans urter tln add OV sebstitiAto additiona tr�ansjQrt$r' r a3Lpen.Lj'faaf "�" '-` . <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATIO : I h rQpydoolarelhatlhe.conlenis of this consignment awfully and accurately described above by ilia proper shipping name,and are classified,packaged, <br /> marked and label�10 <br /> pis�arded,and are in all re pact in'proper condlilon for transport according to app'icabia interb)coz <br /> }arid•^^^���lionai governmental.regulagons:if export shipment and lam the Primary' <br /> E, o r,I certify t the` lents of this,consI nmerfl conform to the terms of the attached EPAAcknowiedgmentmtl. <br /> iiity ACihe v� mi' le"Ilon-slateme 1 f rtgfiedin Q F1t202-.R,202armaimge.quaiAilygoner flrar� <br /> oherp(o /Off or's P' Myped Nemo Signa uro Month DaY Year <br /> 16:tnternationa hipmer s Import : , <br /> I t tSExport from U.S. d ojtanlry/exiC <br /> j Z Transporter signature(for exports only); '~ .ale caving US:, - <br /> w 17.Transporter AcknoMedgment of Receipt of Maleda s112 <br /> Transp rin dfTyped Name I Signat'r6 r+ Month Day Year <br /> CL <br /> I z Transporter Pr nted/i-yped Name Signature Month Day 'Year <br /> 18.Discepaney <br /> 18a.Discrepancy Indication Space quanta <br /> ❑Type <br /> El Residue ❑Partial Rejection Full Re)eclion <br /> i Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) US.EPA ID Number <br /> =.r <br /> U<- Facility's Phone: <br /> w 18c.Signature ofAilarnafe Facility(or Generator) Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Managament Method Ca les(r-a.,codesforhazardous waste treatment,disposal,and recycling systems) <br /> 4�� <br /> 20,Designated Facility Owner or Operator:CerliBcaticp of r celpt of hazardous material vered by Ilia manifestexcsn dIn Itom 18e <br /> Pilo ed Name Signature Month Day Year <br /> Va V51 <br /> EPAorm 87QU•22gRevi2-�?� evlous editions a e o'solete, --� DESIGNATED'FACILITY TO GENERATOR <br /> I. 7436572/14352t <br />