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PFCFIVF--D SEP 2 9 MIS I. <br /> Please print or type,(Form designed for use is! I <br /> .4 Form Approved.OMB No,2050-0039 <br /> 1.Generator ID Numb�r -4 popsoroono 4.Minlrom Tockl Number <br /> UNIFORM HAZARDOUS 1.2,138 1 f <br /> —�VAS�.-E MANIFEST 'Witil L 461 "0 lons2 0 <br /> 5608 ' SKS <br /> 51 GeWalor's Nat-no and Mailing Address Gonorator's Site Address,(If difforenHhan mailing address) I <br /> Y T <br /> '27th St <br /> BACRANE CA 135816-3201 <br /> b NTO I <br /> Generators Phone: 9 16-4,44-252b <br /> 6 r U,S.EPA 10 Number <br /> "MP)�%-OM82998 SYSTEM! N <br /> T I R 0 IN 8 t0'"; <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address <br /> C1 EANHARBORS CAN JOSE LIC U,S-EPA ID Nombor <br /> 1621 BERRYES380A ROAD <br /> S I N JOTS <br /> CA 95133 <br /> Facility's Phone: 408-44 1-096a Cl A 0 1315 9 <br /> ge, 9b.U.S.DOT Description(including Propen0hip:Ang Name,Hazard Blass;ID Number, <br /> 10.Containers 11,Total 12.Unit <br /> HM and Packing Group(if any)) 13,Wasto Codes <br /> No. Type Quantity VVI.Nol. <br /> WA"M p 2 —F <br /> ',S , Dill I <br /> P T f M L El I M HYDROCARBONCSD .N'444 3 <br /> 2. 010 0' <br /> 0 <br /> 3. <br /> n6 <br /> 4. <br /> z-4� <br /> 14.Special Handling Instructions and Additional Info rmodin T. r 6 7 &-t-, 1:3:.:x,,!1'7 9 8 <br /> D-Si <br /> -B00-4i8--1,760 (SK <br /> I In ric P'k3 Qp'. 71 <br /> _IN I P"! <br /> 15. GENERATOR'S1OFFEROR'S CERTIFICATION,Yh rebydeclare that the contents or his consignment and fully'and accurately described above by'llia are'i!IA0,d,packag6d <br /> marked and laboled/placarded,and are In all reipecl;In proper condition for transport according(qappllcablo International a rd nalf6nal governmental tog <br /> ulallons.IfexpOd shipment and I am the Pdnnary! <br /> Exporter,I codify that the contents of This conildrime t conform to the terms of the attached 11PAAdnowl6dgratint of Consent <br /> certify that the waste minimization statement Idlonlin d In 40 CFR 262.27(a)(It lama large quantity generatok or(b)(if I am 4A.Mall quantity generator)is he. <br /> 'Genes tor`s/offeroes Printed/Typed Name signal <br /> Month Do Year <br /> --j 16.International shipments <br /> I- ri Import to U.S. Export from U. Pod of(in kit: <br /> z- Transporter signature(for exports only): <br /> Date.leaving U,8.; <br /> J 7.Transporter AcknoWedgment of Receipt of Mat.e <br /> 134 <br /> t2 Transpgp PrIntedflyped Name <br /> 0 Month Day !year <br /> 4 <br /> ka-2 <br /> TranspoderZPflntedfIP6dN6m8 ton ul DayYear <br /> 18.Discrepancy <br /> 18a.Discrepancy Intildletion Space. <br /> Quanli <br /> f ty E11ype Elp <br /> arlialRejection Fuli:Ro)eot on <br /> Manifest Reference Number,, <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number J <br /> CJ I <br /> LL acilitys Phone: <br /> w. 18c.Signature ofAltemato Facility(or Generator) Month Day <br /> Year <br /> 19,Hazardous Waste Report Management Mothcdcoes(Lo,codes for hazardous waste treatment,d(sposal,and recycling systems) <br /> C 3 1. 1t 12�i 3. 4 <br /> 20.Designated Facility Owner of Operator:Certification of celpt?fhazardous,ma homanife 'Xceplasnoted inItem i <br /> Prinled,. Name signalt 'Year <br /> EPA Form 8700,22(13w.3-00 Previous editions are olowele.4 DESIGNATEFA 3- ILITYTO'GENERATOR <br />