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For Approved.OMB No,2050,0039 <br /> Please print or type,(Form designed for use on elite l'12- itch)1ypavvqeL)--.- <br /> 1.Generator ID Number 12,Pali,1 of �3. margencylle5ponsel'Ono '4.Manifest Tracking Number <br /> SKS <br /> UNIF6RM'HAZARDOUS 62 <br /> CAUVI IZI <br /> g <br /> WASTE MANIFEST ddrosis(If differont1han rn,�add,, <br /> I Generator's Site A <br /> 6,Generator's Name and Moiling kd—dres-s- <br /> i S <br /> Generator's Pitons: US,EPAID Number <br /> S.Transporter 1 Company Name <br /> X, <br /> U.EPA ID Number <br /> 7,Transporter 2 Company Name <br /> 8:Designated Facility Name and Site Address C( r. HAMRS SAN J04AU,S.EPA ID Number <br /> , <br /> 10121 BEHRRYEMSIA Q0(11) <br /> SAN JOSE <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper siiippi g Name,Hazard Class,10 Number, 10:Containers 11.Total 12,Unit 11 Waste CodesWLN61, <br /> HM and Packing Group(if any)) No. Type Quantity <br /> 2 3 <br /> 4 N ,R-t 1HAZOROIX19 <br /> 0 <br /> LU! <br /> Z 2. <br /> Uj <br /> 3. <br /> 4. <br /> 14.Tpecial Handling Instructions and Additional Imormall(in <br /> r91 D-t r1i IT i.'27 '0 4% 13 <br /> �8-- <br /> (SK <br /> OEM <br /> I a proper pp ng name,a a Milled,packag�d, <br /> V" D ric� r_�T I. r1' <br /> ble International and national governmental(egulations.If export shipment and I am the Prima <br /> -k���ORI$CERTIFICATION: consignment are lyand sc6ulatelydesuibedshove irebydecla a contents of this 0ons <br /> ondillon,for transport pocoldiril)to SPON <br /> marked and labeled/placarded i's in proper c <br /> ty <br /> Exporter,I cortily that the conlontsof this cOn$1gnmG nt conform to the terms of the attached EPA AcRtiowledgment ofConsent. <br /> (a)(if I.arn a large quantity generator)or(b)(III am a smaitClUBTIMY 91MATat0f)Is true- <br /> I cantly that the waste minimization statement ld ad in 40 CFR 262.21 Month Day 1 year <br /> ............ Signature <br /> J­15,'1511­1`�i's 1,1111.1ed/Typed Name. <br /> Import <br /> POA Of Onlry/Ox": <br /> 7 iUlntairn-11011-1—AIPmall�s rt tLJ Export from U <br /> Date leaving U.S.: ii <br /> Ko Transporter signature(for exports only); <br /> ctlptofMaterials, <br /> 17,Transporter A6noviledgment ol"R111p,of Year <br /> LU M—n—, ly <br /> Transl: r>1 Rr(ritedlTyped Normo <br /> 0 -416-�L)AY <br /> IL M V) y <br /> Year <br /> cn Signature <br /> Trarrspe 6 P to R No a <br /> III,Discrepancy <br /> Rejection <br /> OType ❑Residue n Partial Rel-afl-n F]Full <br /> i8a.Discrepancy Indication Space Ej Quantity <br /> Manifest Reference Number: <br /> U;S,EPA ID Number <br /> 18b.Alternate Facility(Or Generator) <br /> CJ <br /> Facillty's Phone: Month Day, year <br /> C3 18c.SignatNtIAltemal.Facility(or Generator) i <br /> Z la.waste treatment,disposal;and recycling systems) <br /> (D Hazardous Waste Re anallement MethollOodi s(I.o,,codes for hiazar,do 4, <br /> LU <br /> of localpt of covered t;y.;101nIfesj�exqapt as noted In'llem,188 Year <br /> 2Q.Design —w'wa Month Day1 <br /> -Pi—jntedfTypod Name <br /> GENERATOR'S INITIAL, COPY <br /> EPA Form'8700 2'2 3•p5) Previous 6 are bsolete. <br />