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i <br /> Please pnni or Type,(Form designed for use;on 'lite(112-pitch)typewriter') ? <br /> o Form Approved.OMBNo 2650.0039 <br /> UNWORM HA7,ARDOUS 1.Generator ID Numb r 2, aiTge i of 3nEhier o y Resp nso P one 4,ManifastTreckiii umber <br /> WASTE MANIFEST CNL�1Q�t 146x:350 j Etj -�46 60 y <br /> 100582.1-62,0 SKS <br /> 5.Generator's Name and Mailing Address Geaorator s Site Address{if:dilfarent than making address) <br /> C.i9c�c1 fir a�y?;b�:�1s ttt�: �� <br /> 214 R7th St (�j <br /> 6`f�CRAMENTO CA 9581,6-3201 l.J <br /> Generators Phone: 51 Gw-444—��q25 <br /> ud Kotply <br /> a . a e5 <br /> jVCw U.S.EPA IQ Number <br /> 7,Transporter 2 CompanyName <br /> �— 7 YI�Y�4trr3r` 1?tau <br /> CLEAN HARBORS ENVIRON SCS INC U.S.EPA ID Number <br /> d.Designated FacililyName and Site Address. I :SI �� TOSE <br /> U.S:EPA ID Number <br /> 1 S 1 DEC`R AYES p ROAD � <br /> N <br /> r.� iS "O$C , G 1 5f <br /> 408-44 1--!7rx 1t#80 a}4431t <br /> Facility's Phone: <br /> 9b'U.S.DOT Descri ffon(including Pro erShi m Name,Hazard Class,ID Number, <br /> • 9a. p (� 9 P pP y <br /> No. <br /> Type Quardity Wl:1Vol. y <br /> HM and Racking Gt up.(lf any)) 11..7btal 12.Unit 13.Waste Godes <br /> 0 1.� Z 4`N RGRA HA.;rAR DOUS WAS!rE SOLIDS DP�i � MI <br /> 1 . 6� P~?RC}IrJ~UI�I NffDEtt) It�ONS) 1-4pv <br /> w 2' ' ' <br /> 121) <br /> 3. <br /> 4. <br /> K'Special Handling InstruciionsandAdditional Infomra6o <br /> i T8D i:S>J CI337 GSG t <br /> 24 NR FIMERt ENQ'( #1r�81i121�4.8-1760 (SK Ti 1) <br /> :t qT-1let q <br /> 15. GENERATOR'StOFFERt)R'$CERIP <br /> im r,TIFICATION II obydeclarefhallhecontentsofthisconsignmentara(ullyandaccurate(ydescdbQdabove,byihapropersfiippingneme;:arxiaraciassified,packa ed,' <br /> masted and jlfyj d/Placacded,and are in all resects n proper condilion.tar Uansport according.to applicable international and:natioiral govemmantai regulations, export shipment and I am the Pnmaly <br /> Exporter,i cortlfy.ihaf!fie contents of this consigr(mrmyconforpt to the terms of the attached EPAAcknoYrledgmani of Consent, <br /> rcortify that the waste minimization$tatementidajliiBo in 40 CFR 262.27(a):(If l am a urge qusNf(y.�enef or)or(b)(Iff a ii a small quantity nerator)fslr 9 <br /> Offeror s rinnledlly(po-Nam <br /> r f '` 'Y �: Month Day Year <br /> 16.in amaltonal 9hiprna is ' rl <br /> l_1 Import to U$.v D Export from U.5. Pod of.enhylel <br /> Transportersigg9lura(forexportsonly):, Date.foavingU;S,: — -' <br /> IX 17sTransporlerAckhoWiedgmei1 011 eeiptofmaterials' , <br /> QTranapo PdnledGiyped Name Signeltlr <br /> nIle /',.f Month Day Year <br /> Z Transpo erg rinte yp d ame Signa e' ` <br /> Monih ay Year <br /> 18,Discrepancy / 1 <br /> III Discrepancy indication Space D QuantiN y f� <br /> y D Type ❑Residue D Raifiaitjejeclfan t J Full Rejection <br /> 18b.Alternate Facility(or.Generator) Manifest Reference Number. <br /> -� U S;EPA ID Numbar <br /> u Facility's Phone: " <br /> H18c.Signature ofAlternate Fa lity(orGeneralor) <br /> Month Day Yloor <br /> 1) 19.Hazardous Waste Report Management Method Codes(1, ,codes for hazardous-waste lreelmenl,disposal,and recycling systems) <br /> 4. <br /> 20,Daslynated aGliity Owner or Operator:Codification df roc ipl of h9zardousmaterials covered by the manifest exce tas notedin ile 189 ` w <br /> Prinledfrypedams t1 signal r r <br /> / <br /> lh <br /> on aYea Pay r <br /> Ll <br /> EPA Form 8700-22{Rev. 60 Previous adill n are obso e; " <br /> 1 )7488572/74 525 1 ESIGrNATED FACILITY TO GENERATOR <br />