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it <br /> SR SH Ift .2195615865 <br /> +~Plea' orint yr type,(F3rm designed for use on elit�.1 .pitch)tydewriter, Form Approved.ON-113 No,2050.0039 <br /> 1.Genarator I trher 2.Pa716olEmergancyResponse Phone 4.Manifest Tracking Number <br /> t1NIF STE MAZARp0U9 q « 1.^SO0 'tL�c�r 17&?Z ��� '� ��?..:J SKS <br /> WASTE MANIFEST <br /> 5.Generator's Name and MailingAddress 7, Goneraior's$Ito Address(if different than mailing address) <br /> GiicoyAi,r sy'5ta:ars Irr. <br /> 214 4711( Si7 _ <br /> '^�t <br /> Generator's Phone: 91,144•w.,5c_5, COPY <br /> 6.Transporter,1 Company Name U.S.EPA ID Number <br /> SAFETY—KLEN S-Y8TV Sj tri i TXR6110081 ,0 <br /> 7.Transporter 2 Company Name U.S,EPA ID Number <br /> B.Designated Facility Name and Site AddressU.S.EPA ID Number <br /> 'AN HA7,RB'OR'S BAN JOSE UX <br /> 10i 1. $EiRft ESSA i•2OAD <br /> Fatuity's Phone: <br /> 4.08-441-0962 i � r _ CAD05949�Y310 <br /> ga, 9b,U.S.0T Descriplfon.Onciuding Proper S ippf g Name,Hazard Class,10 Number, 10.Containers %T0181 12.Unit <br /> and Packi( .Gr up n tan '--' 10,Waste Codes <br /> HM y)) I No. Type Quantity W(Voi. <br /> rr i�-NQN}� Wk�L>Y610N qR?CTf}tr� H)€t�Z{AR '"IL)3 WASTE SOL IDS, Cil P �23 <br /> 2 <br /> 3. <br /> 14.Special Handling Instructions and Additional Informaffo <br /> UD 7 S.1 71,3;5>N3 47 C 133 71 13 CS6 <br /> i <br /> 24 iii# EMiMENGY #1-00 t jQ6'i"t 760two{ 17"i I I <br /> L"! � �: a <br /> 15. GENERATOR'StOFFEROR'S'CERi1FICATIQN;.L e,iaby declare Utat the carilents ofthis consignment are tullyand accurately described above by the proper s ipping name,and are classified;packaged, <br /> marked and labeledlplacarded,and:are in all resects+n:properconditfon for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignmenconform to the terms of the attached EPAAcknowiedgmelrt of Consent. <br /> I certify that the waste minimization statamenf idaiitifte In 40 CFR 262,27(a)(if I am a arge quantity or(b)(if 1'qm a small quantity generator)is true, <br /> 791oes/Offoroe.5 Printedri ed Name _Signature Month Day Yanr <br /> -i 16.Intamauonal Shipments <br /> j O Import to U:S; FF"xpod from U.S.. Port of anirylexib _ <br /> Transportecsignature jfor exports only): Date leaving U.S',: <br /> w 9 p y� <br /> Transrpns ort Printedrtyped Namof Receipt Materiala Y Sigr�atu( Month Day Year <br /> p <br /> CL A <br /> Z Trangpo ergri .d .pe amq sigrialow, Month Day Year <br /> 16.Discrepancy r—� <br /> i6a:Discrepancy IndicauoeSpaca qua i4 ty ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> I <br /> Manifest Reference Number <br /> 16b.Alternate Facility(or Generator) U.S.EPA ID'Number <br /> J_ <br /> U <br /> W Facility's Phone; <br /> 16c.Signature of Alternate Facility(or Generator) Month Day Year <br /> t-- <br /> N 19.Hazardous Waste Report Management Method Cooes(I e:,codes for hazardous waste treatment,disposal,and.recycting systems)71 <br /> T <br /> 1. 23i d, i <br /> QwnarorOperatorCerbticaonofe iptbfhazardousma(edmaterials covered the manifestexce t as inItem 16a20.DeslgnatedFacility <br /> f ( Printedrfy ad Name Signa f Month Day Year <br /> EPA Form 8700.22(Rev.3.05) Previous edilions are': fete, �' t7; ICf lAl D FACILI7`(T'(7 G"cf I rF A Fl <br />