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A r/ <br /> 30 <br /> Please prl or type,(Form designed for use on lite 12-'Pilch)lypewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1•Gonerator lD Numb'r 2•(?pg 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST CAi.t�t' tt) E!g 1— 60-17EO --006466z";40 $KS <br /> 6.Generator s Name and Mailing AddressGenerator's Site Address(f different than mailing address) <br /> Cisc.o Air.'Systems I c <br /> 214 27th St <br /> 191ZRAIMC (A-.. _ CA 95816-•:201 p <br /> Ganeraiors Phone: �, <br /> 6.Transporter t Company Name, U--u—s7tioA ID Number <br /> SAFETY—KI,FI~hi SYSTEM I TX R001308 t 2Q`r <br /> 7.Transporter 2 CompanyName IU.&EPA ID Number r <br /> rL.EAN HARBORS Ehf'IRD VfEfliTAL SVC INC. [rl61P 2�r <br /> 0.Designated Facility Name and Site Address I , U.S.EPA ID Number <br /> MEAN HARBORS SAN JE <br /> ME <br /> i W7 l SEFtFtYESSA ROAD <br /> � <br /> Facility' �408-441-11962sPhon408-441-11962Sf N JOSE CA 9's 13:3 <br /> i <br /> g©, 9b.U.S.DOT Description(including Proper Ship Ing Name,Hazard Class,ID Number, to,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes'', <br /> 1. � i <br /> No. Type Quantity WI.Noi. <br /> Ce ri 40AI RC-RA HA A=?�DOU WASI'VE,801, I. )?frl A 22124 <br /> •. T 8 PETROL.FUM YDRCicAt,I3i <br /> Z' 2. <br /> UAt <br /> 3. <br /> 4. <br /> I <br /> 14,Special Handling instructions and Additional Infoslid <br /> i 51 a J 76660383 0138793 <br /> W HR E111 WEN <br /> Cy #1-",8 01$8-1780 (CH / SK f TFI} <br /> t5. E R'SI 'S ICA f • y d c re t'i nfs f i3`�n �htiidnt rt1. y ah0�d r tb d's rib, o. 8itt p t ping name,.and are classiged packaged, <br /> marked and labeledtplacarded,and are in all respect In proper condition for transport according to applicable intemationaland national governmental regulations.if export shipment and i am the Primary; <br /> Exporter,I cortity that the contents of this conslghmer t conform to the terms of the attached EPAAcknowledgment of Consent. P <br /> I certify that the waste minimization statement Idprififli din 40 CFR 282.27(x)(if I am a large quantity generator)or(b)(if I am smafl quantity ge r or) <br /> e era FWOfferor's PdntadtWdNam —Montha Day Year <br /> l� ,I <br /> IZZ 11/v <br /> L i6.International Shipman ; <br /> w 0(mport to U`S. ❑Export from U,S, on of enhylexitt <br /> ? Transporter signature(for,exports only): te.leaving U.S,: <br /> 17.TransponerAcknowiedgment of Receipt of Material f •' �. <br /> OTrans0 P'niedffypadName Signet eJ �/' y� Month Day Year <br /> CL <br /> ZZ <br /> � Transpo r 2 lint yped Name �� <br /> �d g Mon Day Year <br /> 18.Discrapancy <br /> i8a.Discrepancy Indication Space <br /> ❑Quantity I ❑Type F-1 Partial ecuon Re <br /> j ❑Full Rejection <br /> .I <br /> +.Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) UIS.EPA iD Number <br /> V <br /> L Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> d <br /> 19.Hazardous Waste Report Management Method C es(f. .,codes for hazardous waste treatment,disposal,and recycling systems) <br /> '7 i. 2: � 4 <br /> 20.Designated Facility Q ner or Operator:Certification,o re elpt of ardous materials covered jty1he manifest except a tided In!!gym 1 a' f, <br /> Prinlec[M,ed Name Signature —"' r Month Day Year <br /> EPA Form 6700-22(Rev.3.05) Previous d!tion ar sot ele. DESIG 9 EO FACII ITY TO GENERATOR <br /> t <br />