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'2S(.. S9 SF111-'i} 2291597007 011111 11181111 <br /> 0 0 7 1 5 7 4 0 4 S K 8 <br /> Please pant or type. Form Approved.©MB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number IMC-enerator's <br /> 3.Erne nay Re pee Ph T007157404 <br /> Nlanitest T ng Number <br /> WASTE MANIFEST CAf`0004078431—R� T-911�'� SnS <br /> 5.Generators Name and Mailing Address Site Address(if different than mailing address) <br /> [stand Marina <br /> 1.157-0 W 1 ii oht Mile Rd <br /> TOf--T.-'' CA 9521.9-8708 <br /> Genarators Phone: <br /> U.S.EPA ID Number f,, v� SYSTEMS T NC TX FtOW0081 PO5 <br /> 7.Transporter 2 Company � U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HRR8rORS SAN in-9E U.S.EPA 10 Number <br /> 1021 B1=RRYESSA ROAD <br /> SAN JQF , t�A 95133 <br /> 40&-441-0962 C€�T) 5948431 r� <br /> Ftrcit s Phone, <br /> ga. 9b.U.S.DOT Description(tnduding Proper Shipping Name,Hazard Class,ID Nurnber, 10.Containers 11.Tse 12.Unq <br /> HM and Padd up(If any)) No. Type Quantity 12.Un 13.Waste Crites <br /> z 1' NON RC'RA HAZAR1)01JS WASTE SOLT11 0M 352 <br /> {A, _:��1;BENTS CONTAMINATET� WTTH Oft-) , I <br /> a oo <br /> 2. {I <br /> w <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Petmatfon S :5.7 81348735 35 K 16407 CSS y ] <br /> f <br /> 4�d Fd+IERCFIVCY#8t — 68—176 —CFE SI4fTFT—Col tract re gi �y generator c onf tn� �� ertr att cri 4r <br /> rr r r t <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION., I hereby declare that the contents of this consignment are fully and accurate described above by the proper shipping name,and are classified,packaged, <br /> marked and 61*180ac4rdad,and are in all respects in proper condition for transpOrt aocording to applicable inlemational and nadonai govemmentai reguhations.If export shipment and I am the Primary <br /> Exporter,I COARfy that the contents of W9 consignment conform to tit tarms of the attached EPAAeknow ledgmant of Consent. <br /> I certify final the mart identified in 40 CFR M,27(a)of I am a range quantity gartfator)or(b)(if I am a small gnaar;*generator)is true. <br /> GeneratorslONeror's Prtn me Signature Monfir Day Year <br /> E 16 International Shipments <br /> F- Import to U.S. ❑Export from U.5, Port of er fexit <br /> ? Transporter signature(fot exports only): Date Ing US.: <br /> ce 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Tra porter 1 Printed(Typed Name nature Month Day Year <br /> S <br /> 2 41TYPed N Month Day Near <br /> 18,Discrepancy <br /> 18a.Discrepancy Irrdivation Space <br /> ❑ Quantity ❑TYPe ❑Residue ❑PaAW Rely ❑Full Ruction <br /> Manifest Re(erence Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA tD Ntnrtt:ar <br /> .� <br /> Com. <br /> u. Facility's Phone- <br /> C3 <br /> 18c.SignatureofAlternata Facility(or Generator) Month Day Year <br /> a <br /> 19.Hazardous Waste Report Management Method Codas(i,e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1 2. 3, <br /> 4, <br /> 20.Designated Facility Owner or operator GertAfcatfon of reeelpt of hazardous matenals covered by Bre ma ifest except as Wed in Item 1 Ba <br /> TntWTypad N gnature ay, ear <br /> EPA Form 8700-22 Rev.12-17) Previous editions are obsolete. p� IG ED F T1'TO pA's e- IA�IIFEST SYSTEM <br /> 1.)76�1?18s814355 <br />