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:r <br /> f?t"i Vis); s lbf b Pit '2- 41',".30., <br /> Please print or type.(Form designed for use ondile,12-pitch)typewriter) Form Approved,OM©No.2050-0039 <br /> a UNIPOPM HAZARDOUS I.Generator ID umber o 2 Page I of .3.Emergency Response Phone 4.Manifest TrackingNumber <br /> WASTE MANIFEST l;�'ti..�'0'0%1►;r3�G0 1 nn t, 1tt GM17>.0 00' x.3.1.41. SKS <br /> S.Generator's Name and Mailing Address v Genorator's 8110 Address(if different[ban maViingaddress) <br /> tis(:u Air austemi lit: I <br /> c'14 pR�r7 IJI St; <br /> Go <br /> 6.Transporter I Company a U.S,EPA ID Number <br /> 7.Transporter 2 Company Name 1 ; U.S.EPA Ill Number <br /> n.r-PiNj PNVTqr1Nim t*I%ITQI <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> C-EAN HARBORS SAN JOSE <br /> I 21 DERRYE80A ROAD <br /> S`' N MUZ y CA x`311.35 <br /> 's Phone: 11?11D-44.1-0961c 1 A"(0M4M4 10 <br /> ga, 9b.U.S,DOT Description(including Props SWping:Name,Hazard Class,ID Number, 10.Containors 11,Total 12,Unit 13.Waste Caries, <br /> H61 and Packing Group(if any)) No. Type Quantity Wt,Nol, <br /> t, I 7y� - <br /> Q NOt`•} RiotRA H1 �1 ?7C1:J f Jl tJ }.,LLwq D11 ., J <br /> LZ 2, <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Addi—nat in(rmat,on <br /> 84 HR E:MEPIGJ �EY #1-80 «.468-1760 MK I TF1.) .. <br /> 1 GEFI �R'St F '$ CA d vara o t t f hl Ali icy a r�dTi tit I.i s4riti AoV t g I ptngname,and are dass ifisd,packago d, <br /> marked and labeiedlplacarded,and are in all r spec in proper condition for transport according to applicable Intemationafand.nationai governmental regulations.If export shipment and I am the Primary <br /> Exporter,l certify that the contents of(his co s nm nt conform to the terms of-0ie attached EPAAcknowfedgmep of Consenh <br /> Pceriity That the waste minimization staternerW donti ed In.40 CFR202,27(a)(If I area large quantity gonarat r o b) ),_ small quantity. neiator)Is t <br /> enerator'sfOft sPdnted/TppedName Signa re Month Day Year <br /> —r 16.Intemational Sl't pments t—t I ( J I <br /> F ❑Import toU.S. EJ Export from U.S. Port of entry/axil: <br /> Transporter signature(for exports only): ( � ate aving U.S- <br /> 17.TransporterAcknowledgmentofRecelptofMaterils <br /> aTranspe 1 Printedf('yped Name Signet Month Day Year <br /> QTransporter to ped Name .wf' Sign r r Month Day Yea <br /> E 18.Discrepancy <br /> i I--� <br /> i8a,Discrepancy Indication Space ❑ Qusat N tJType ❑Residue ❑Partial Rejection <br /> Full Rejection <br /> I <br /> Manifest Reference Number. <br /> h 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> 1 <br /> c.> <br /> rQ Facility's Phone: ' <br /> LL, 18c.Signature o(Altemate Facility(or Generator) Month Day Year <br /> d <br /> Z <br /> 19.Hazardous Waste ReporPManagement Method C des(W.,codes for haiardous waste treatment;disposal,and recycling systems) <br /> w I. 3. ' T <br /> o <br /> 20,:Designated Facility Ovrner or Operator.Cortificali n ofec ipl of hazardous materials covered by the an i Vst except as doted in Item 18a <br /> P Hied ams SI lot <br /> YA0 ► ' C _ i � <br /> k EPA Form 8700-22(Rev.3.05) Previous editions a e ob olete, <br /> DiESIGNAT tLiTY TO GENERAT R <br /> t •Y <br />