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W P# 2272k7I14t. <br /> Jlease print or type, <br /> .9 Z. Form Approved.OMB No.2050-0039 <br /> UNIFORM WARDOU erator ID umber <br /> TE E S 'o 7cy,ResponlrM 4.Manlfiit—Trackfno Number <br /> i <br /> WAVE MANIFEST <br /> _M <br /> 5,Gane'.I. ,no GG6726857 SKS <br /> es N and Generators 61teAddress(if different than mailing address) <br /> cis,ce Air, Systems It C <br /> P14, 27th St' <br /> SACRAMENTO CA 93816-3201 <br /> I Nic mss. I'D Number <br /> 7.Transporter 2 Company Name I U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRM114 NTAL SVQ 91C. <br /> T Designated Facility Name and Site Address <br /> CLEAN HARBdRS 'SAN JOSE U.8,EPAIDNumber <br /> 1024 BERRYE8M ROAD <br /> SON JOSE CA gal <br /> Facility's,Phone: CAD059494310 <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,16 Number, 10.Contain fl.Tot <br /> HIM and Pecking Group(if any)) -- at V.Unit 13.Waste Codes <br /> No, Type Quantity WuVol. <br /> NON RCRA M ARDOUS DM <br /> P 223- <br /> 0 E S, PETROLEILIft HYDROO,RBONS) <br /> Z 2.' <br /> LLJ <br /> 3. <br /> -R ECEIVED JA N, q 2019 f-' <br /> 4 <br /> 14,Special Handling Instructions andAdditional Infer <br /> nalloIr': TSD;SJ 78576606 C 133793 <br /> 24VI FMERGENCY*800-46&�� 7 0--CH/BK/TFT--Cont-f%aCt retained by <br /> pnerat-or dorilf <br /> (in irtltial ers aVency acts horit <br /> ti�:Iancipn v- Ad or SLIb4iii-tite addl,.tio.11a ti-Angpnr�jn .12 -a,mio <br /> rn nn @,,my A, <br /> 15. GENEAATOR'SIOFFEROR'SOERTIFICATIOR I hereby declare that the contents of this consigni accurately describedebove by the proper sh a name,ard ate$assilled;packaged,nen.1 are fully and <br /> marked and labeled1placarded,and aro In all res)eclsiln proper condition for transport ecco <br /> fdIAgt08ppIIC0bI0, emagonai and nationa)-govemmental regulations.if export shipmentand <br /> Exporter,I carlillyffiat the contents of this c6nsipmeni conform to the term ofthe alladhedlIPAAck of, nt. nd I am the Primary <br /> lly that the waste minimization stalernenLidi nlifl�d in <br /> 40 CFR262:27(a)(if Pam a large quanfi y <br /> t <br /> lk f,itfa lily generator)Is Prue. <br /> odeinarat ffarot's PrinledfTyped Na <br /> Sighatur Month 06Y Year <br /> —j 16.International Shipments <br /> 0 U <br /> D'Exporl fr0m'61. i <br /> S, <br /> of entrylexil: <br /> Z Transporter signature(forexporis only); <br /> UP",.leaving U.S,: <br /> W 17, of Majeflaj� <br /> oTran P ted[Typed Namegna Montk Day Year <br /> CL <br /> 4 11 Z 1/4!5r <br /> 15 <br /> TransporiftfPfintedfryp6a Name �S!� <br /> r <br /> 99 u Month Day Year <br /> 18.Discrepancy <br /> Ills.Discrepancy,Indication Spats quantity <br /> 0 Type qResiduo Dperlla'l Rejection <br /> Manifest Reference Number: <br /> 18b,Allernato F00ty(orGeneralot) U—S.EPA ID Number <br /> -4 <br /> Facllilys Phcn6f"', <br /> hiownill Day Year <br /> 19.Hazardous Wastj RVpop Manageoent Method Coch codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1, 2 <br /> 14.1 1 J <br /> 20.Designated Fadhty ner oporhlor,Cerilli4flon i If t4ol ofhuardou8 maletialsi.covered by thamanilost except ainjo <br /> oqr6rn <br /> P(Inled/Typed NameSignalure <br /> of <br /> Ll )fAA1 <br /> CPA Form 8700-22( ev�.'L7)Yrividus idffl�oms 'En PACII ITM GENERATOR <br /> I)743657 2/(14315)85 DESIGN <br />