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t <br /> :SAE SK 4111 # <br /> Please pririf:or type.(Form designed for use on allta,( 2•pitch)rypewritor.) '�' ForniApprovod.OMB No;2<550 0039 <br /> UNIFORM HAZARDOUS1 Generator ID N umber ?.,1?age i of 3.Emergeneyriesponse Phone jd05 <br /> Manifest Tracki <br /> ng Numberr� I <br /> ~ WASTE MANIFEST `i EA tib 14 r f 0 ( �'a7 4 l3� SKS_ <br /> �( 1 <br /> 5.Generator's Name and MailingAddfess Generales Site Address(ifdifferent than mailing address) <br /> Cisco, Ai systems 1116 <br /> 214 a7th $t . <br /> 8ACRAM NTO t,xl 95@ 1 t,•c32o l Copy <br /> Ganeralor's.Phone: 1 tr ilk s:7 <br /> 8.Transporter 1 Company Name U.S EPA ID Number <br /> SAFETY-KLEEN SYSTEMS,', 'NC. <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> i <br /> CLEAR HIA' BARS ENO-RON Ka. SNC <br /> 8..Dosignoted Faci lly Name and Site Agdtossp�j,. flN. QSE U.S.EPA ID Number <br /> 1'12181 13ERRVESSA OOAD <br /> 8 N JOSE CA 95133 <br /> 4rZi8•�441...��3�i� GN0���31r•��t,3 t!4� <br /> Facility's Phone: T __ <br /> ga, 9b.U.S.DOT Description(Including Proper;Shl I iing Name;Hazard Class,10 Number, 10;Containers i1.Total 12,Unit 13,Waste Codas <br /> HM and Packing Group(if any)) No. Typo I Quantity WI.Noi, <br /> 1.1 SN RQRA HAZ.A nous WA-TE SOLIDS DMP` 2'23 <br /> 0 ( E11 I E t PETROLEUM Y'�owk 'ioYs),-' r 9 <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> I, <br /> KSpacial Handling Instructions andAdd@onai Infotma8 n f j <br /> 4 NR E IEkIt�E.NQY i#1.80 .w4, d-1760 (SK 1 TF1) ^ ��/ <br /> 15. GEtJHRATOR'SIOFFEROR'S:CERT FtCAT10l;I erabydec are;chat the contents o 1h s cans gnmentara lly and accurately described above the propersnipping name,and ars classified,.paekaged, <br /> marked and iabelewplacarded,and are in all r9spec s in proper conditionfor transport according Jo applicable International and national governmental regulations.,It export shipment and I em the Primary, <br /> Exporter,I cenlfythat the contents of this 6onsignme nt conform io theterms of the attached EPAAcknowledgment of Consent. <br /> J�qqrflfy that the.waste minlmization s'Oement Ident1l led in 40 CFR 28227(a)(if I am a large quantity generator)or(b)(if t am a small quantity generator)is true. <br /> ne 'foeslOgemrs Printed/Typed Name Signa re Month Day I Year <br /> y ,t iz <br /> 18.Inte-mational Shipmegis <br /> p_ s' ❑impart to U.S, El Export from U:S: Port of antrytexlC <br /> .Transporter signature(for uxporis only): Date leaving U.S.: <br /> V.TransporterAcknowied ment of Receipt of Materials s <br /> 9 P <br /> jTranspo TIPAnted/Typdd Name Sfgn tt9Month Day' Year <br /> jCL <br /> j <br /> Tr`ang'p rfanf?rihlei d'Name Signature Month Day Year <br /> 18.Discrepancy J <br /> t8a.Discrepancy indication Space <br /> ❑ QuantityType QResidue ❑ParUatReJaction ❑FuiiReJeclibm. <br /> ManifestReference Number, <br /> M 18b.Alternate Facility(or Generator) U.S:EPA ID Number- <br /> U <br /> Facilitys Phone: <br /> w 18c.Signature of Altemato Facility(or Generator) Month pay Year <br /> 19.Hazardous Waste Report Management Method Oodes(Lo.,codas for hazardous waste treatment,disposal,and recycling systems) <br /> W1, V. <br /> 20,Designated Facility Owner or Operator:certification of receipt of hazardous materials oovered by the mantle t ell pt as noted in item 18a <br /> Printadff e 51gnah r M th Y�3 <br /> EPA Form 8700.22(Rev:3.05) Previous editions a�e o solete. [7ESJGNATE ITY TO GENERATOR1)7436572Y74;35c.5 <br />