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sl:;Ft� <br /> 61180083611"91 SCPPW 10.+10%2017 <br /> Please rinl or ly id"(Fane rhlefgnsd for use on olite(112.Ipitchj lyp@v0tarj I"erraApproved.OMB No"2050-0039 <br /> UNIFORM HAZARDOUS 1.Genera w 10 Number P. Fmurnmcy RMpnn,c 11N.v t Mml Nnt Trncldng Nvrber <br /> WASTE MANIFEST CAR 0 0 0 2 2 2 5 6 2 2qe 3.{800)483_3719 011685956 FLE <br /> i r1%&l Wrr]Mq...jmdryn r'.Encnmea Sim Aokhrss it djffmant kNM mnlMp udrhru[ <br /> 1000 Cobb PLa¢e Blvd N W 11950 South Harlan Road <br /> Kennesaw.GA 30144 Lathrop,CA 95330 <br /> ufvaprlar 1 C4,ripuy Name US,EFA0 M-utow <br /> Clean Harbors Environmental Services,Ina MAD 0 3 9 3 2 2 2 5 0 <br /> 1 Irmp"r 7 Company.Nance U.S,EPA@ l MI" <br /> Destpnsaerd rarely N9me and 59sRddreas U.B"EKIO Hunner <br /> Clean H a►bars San lose LLC <br /> 1021 Berryessa Road CAD 0 5 9 4 9 4 3 10 <br /> San Jose,CA 95133 <br /> rVailit Phone' 14081441-0962 <br /> gy 9b U S OUT Description(including Proper Shlpphg Name,Hazard Class.IO Number, 10.Conlin ers 11 Told 12 Unit <br /> HM and Parking Group of any)) No. Type Quantity WIJvol. 13 Wade Codes <br /> 1.UN1950,WASTE t AEROSOLS.FLAMMABLE,(EACH NOT o 001 D F 00005 p 13001 551 X EXCEEDING i L CAPACITY),(AEROSOL(CLEANERS)],2.1 <br /> z z UN2994,WASTE HYDROGEN PEROXIDE.AQUEOUS utlV1 DO1 <br /> X SOLUTIONS,(CLEANER,HYDROGEN PEROXIDE),5.1,PG III 0 0 i D F 00:L45 P <br /> 3 UN3264.WASTE CORROSIVE LIOUID.ACIDIC.INORGANIC. 0 01 D F 00145 ^p D002 551 <br /> X N.O.S_,OVERT,GLYCOLIC ACID),S.PG II <br /> 'l UN3266,WASTE CORROSIVE LIQUID,BASIC.INORGANIC, uwc 551 <br /> X N.O.S.,(AMMONIUM HYDROXIDE,SODIUM HYDROXIDE),8,PG 002 D F 00245 P _ <br /> iaiapr6 'irrstruciions and 'bon 175 rLtt lir 0!Ctl <br /> 2_L=O ERG#140 iXS5 <br /> 3.LCCBA ERG#154 1X55 <br /> 9_LCCRD ERG#154 JX55,IX30 <br /> 1b, CzENERAMR'&GrFEROR'3CERTIFlCATION:Ihefaby dadare that tltatontenls of tldswnsfgfanenl�fusy and accurately dearrRnd pba'N by lha pmpn shipplPC nacho,ondrua Basal d.poclinged. <br /> marked and labeledlplacarded,and are in at respects In proper condition for Iraxapataxording lospplkable Inlemalional and national govgrnnreNal fegulaWrrlt.lrezpodat+Fnannl aid I mm the Pmnary <br /> Exporter,I certify that the contents of this consignment mnbrm to the terms of the attached ENA Adneowk mixul.or Consent <br /> I rndrry Real 11M waste minimization statement Identified in 4a CFR 262 21[a)11Y am a Ingo gmft prism"or(b)(d I am a small 71115fpy.9erwralml Is hue. <br /> :M' rrff'.'tl do yped None n ay r <br /> DAVID ( I(�y{� 02 19 is <br /> 1a international Shipments <br /> 1.— ❑Import to U.S. ❑Export from U.S Pal of entry/exit <br /> z Transporter signature br exports on : Dale leavN U.S.: <br /> 0: 17 Tmnj, V.r�ner ARkrxAdadgmnllf al Reor pd of MxkNM <br /> TIWZ. "vtee PMread Nam. naMwh Day <br /> Mr <br /> ERIC CATTELL 02 i9 i8 <br /> zQ Transponer 2 PirledfTyped Now slamone month y ear <br /> K <br /> M- <br /> 1S.Onuolmncy <br /> 1 I6a Discrepancy lndicalionSpam ❑Quantity ❑TyPQ ❑Residue ❑FullRajefdbn <br /> ❑Partial R'action <br /> MamYey RohuraipeM1?Jmlmr. <br /> lab Altemete Fardily(or Ganeraiq B-S.EPA ID Hunbez <br /> J <br /> U <br /> a <br /> LL pae1Y a Pham" <br /> W I[. gnalure aC+nativ Faridy(er Generator) IA npt yw , <br /> H <br /> z <br /> z <br /> h19 Hazardous Waste Report Management McOrod Codes(I.o..codes For hazardous waste lmalrravA,disposal,and recring systems) <br /> 1 Hi4i H14i �' H14i ' H141 <br /> 20.Deapgnalid Far owner or OiNWAC C&LICANNI Ofrxdp! azanlo-rs mamdals r, Od maniMrr upt zn amt <br /> nn Nn g nth Year <br /> EP,r4 F111'ril@700-22(Rey]-0.ril PrOy uu,edit o�tc II b g (_ITYr TO DESTINATION STATE ) <br /> Clean FIarGGars has a aApr prlate a rl rand will accept the waste the enc t14 (IF REQUIRED <br />