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' RCI1n Ali SK 6h• Fi; 1* . d ; 01 <br /> Please print or l' e, f.GenaralorlD u b1212 ?51 <br /> y e psa 146%r k FormApprovad,OMB No<2050.0039 <br /> p 1P er 2 Pa Yet 3 Em �} n ,Pqq�� �Q 11p�",�'��y�i <br /> UNIFORM NAZARD+St)S m' <br /> CAL@01211:4631 ~*36�tr d f `J aid�,#fJ td <br /> WASTE MANIFEST <br /> SKS <br /> 5,Generators Name and hiailing ddre '��� Generator's Site Address(if different than mailing address) <br /> Cisco Air Sysl.c110s I 1 <br /> 214 47th �t <br /> SAC.RtaMENTO Cts 95F116� c01 <br /> r Gonarator'sPhona; '� � j <br /> 6.f "�'�° �` e SY9TEM IiN�: U.S,r Pn io Number TX R00u�0q 1 05 <br /> 7.Trans tier 2 Co'pan Name U.S.EPA ID Number <br /> CL flh! hlFl•(%ON" ENV }1 $�t+l N Cf1L. UC INC, W1,0039,322250 <br /> 50 . <br /> 8.Dos!gnaled Facility Nanta and Site Address CLEAN HARBORS SAN JOSE U.S,EPA ID Number <br /> 1021 BERRYC SA ROAD <br /> 5( N JOSjECA 95133 <br /> ' ��i��•4�1w�t9�ic'� ', ' - .. _... CFi1?ttl"S�'�1'�431�J <br /> Facility's Phone; <br /> ga. 9b.U.S.DOT Description(intruding Prop:a Shipping Nanip,Aazard'Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Typo Quantity W1.1vol. <br /> 1. NUN'fdCRA HAI ARi}(JUS WASIE au J:ns, DN P e23 <br /> © t1) AISq P= TROLEIJ HYDROCAFt0, WW-0 <br /> Uj <br /> 2. <br /> Uj <br /> 3. <br /> r <br /> 4. <br /> i <br /> k <br /> i <br /> 14;Special Handling Instructions ondAddillonal Into matipnC •�; <br /> TSD 3 8J <br /> 240 EMERt:ENC4800--468 17-0-CH/SK/TFI-,Contrtact retained by gen rG' for ctinfoir' :a *e-ngy authar.it y ' <br /> on initial,tr'an5 order to add or substitute addsti.onal try n �rol�terf nn g neva oi^'s behalf. <br /> 15. GENERATOR:S/OFFEROR'S CERTIFICATIO : Ih reby declare that the contents ofihtsconsignmentare fully and accuiately described above by the proper snipping iname;and aro-classified,paekaged, <br /> marked.andiaboted/placarded,and are in all re peci in proper condition for transport according to applicable international and nallonal:govemmenial regulations.if expoA shipment and I am the Primary <br /> Exporter,I certify that the contents of this const nmant conform to the terms of the attached EPA Ackoowiedgnt of G sen <br /> f-Fire lily thal[the waste minimization statement i'entif d in 40.CFR 282,27(a)(ifl am a large quantity generale o (b)(I I am a syquantity generator)Is true. <br /> 0aror's PdntediTypad @ Signature. Month pay Year <br /> U <br /> 16:International Shipments <br /> Import to L,S, ❑Export frorn;oi of enlrylexit: <br /> ti Transporter signature(for expor(s only}:Y ' a leaving U.S.: <br /> I w 17.Tran rlei�erAcknovAedgmentof'RocelptofMalaria <br /> Trans PdntedlTyped Name Signe Month Day.' Year: <br />` 'O <br /> free-TTpri k:iff,y ed Name <br /> � <br /> 18.Discrepancy <br /> 189*.,Discrepancy IncitationSpace' Quaniit ❑Type ❑Residue <br /> 0 Partial Rejection ❑Full Rejection <br /> Manifest Reference Number; <br /> ir, 18b,Alternate Facility(or Genarator) w U.S:EPA ID Number <br /> U <br /> r <br /> Facility's Phone:' <br /> y <br /> QS c.Signature ofAiternale Facility or Generator Month Oay Yea g. <br /> 19."Hazardous-Waste Roport Management Method Co(as(fp.,codes for hazardous.wasletreatment,d(sposal,and recycling aystems).,, <br /> j 1 14. <br /> 20.Designated Facility Ow✓nar`orr.operator;Certification of re ip¢.of hazardousmaterials covered by the manifest except as ed in item 188 <br /> Priniedlfy me Signature Mo 1 Y <br /> ICA <br /> EPA Form 8700.22(Rev,12.1Previous editions ar obfsolete. DESiG RD FACILITY TO GENERATOR <br /> 1)7436572/7435-2-5 <br />