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3195 N. Naglee Rd. Record ID# PRO528542 <br /> 11/5/2020 Program: HW <br /> Photo 30: The following uniform hazardous waste manifest (006952639SKS) observed with signed copy. <br /> SSL <br /> ENc sli�or zerre+r6 i <br /> Oma No 2950.ee39 <br /> UNIFORM NA7ARDOIIS ' CRL000231732 °' a�69�52639 SKS <br /> WASTE MANIFEST <br /> Tracy•Nis 'Rd <br /> rce, G.nmwh 5ne F44rav 144Raronr Oren mani,q eatlreasl <br /> 3195 NaOlr: Rd <br /> TRACY CR 95304-7319 <br /> 5l0-235-7979 <br /> SYSTEMS INC us.avwlo ra,mmar TxR0000B1265 <br /> woer <br /> BOzeoeFaer N.me us.Ecnro N„mna <br /> CLERK HARRS ENVIRONMENTAL SVC INC. MAD039322250 <br /> ao.s,ge.,e;d.aaurr Ne,.,•�na s.N Fmxe.x CLEAN HARBORS SAN JOSE us svAlo rwmem <br /> 1021 BERRYESSR ROAD <br /> 408-441-0962 SRN lost= CA 95133 C.ADW59494310 <br /> 4a !Ib t15 DOT D—Pilon Ilrrinding F,par ShWeg Nerrre.H—Glass,lD Nvmber, le.Gonlwners 11 TOW4 12.11N1 13 Waale Go4ea <br /> NM and Pacxing Group fd enYll Ne- TYFa OoandN WtNW, <br /> O , FIG <br /> NO <br /> 1� <br /> w <br /> 2 2-U'[) P 352 <br /> �- (RHSbRBENNTRANDA p �ARDOUS WASTE SOLIDS, DM <br /> SULID <br /> M <br /> ­71 <br /> 4 <br /> 14.Spe ar handling msttmctions nMAddisunal Information TSD:SJ 79251012 TR34020. r ,y� SG 7 <br /> P4H ENERGG*'28 NCY*800-468-1760—CH/SK/TFY—Contract retained y g aerator confers vy auth ri y <br /> on initi trans o r t d r substitute add'ti rt .-M!,rs <br /> 15. FENERATOR' FF RDR'I CERTIFICATION:I herebydoc are that Ne contents oco <br /> f thlt neignmenl arelully and cu <br /> ety described above 6y Iha er shipping name.aid are 61e0.pactcagea, <br /> marked antl eledt lararded.and are m alespects in l rprop er...6,on fertranspon according i—PPI—ble Int. nol and 'nal gwam u'alwns.if export shpmenl and I am the Primary <br /> Exporter,I dify l 1..contents of lhm—.9nment conform to the terms of tha attached EPAAck-odedgnre or c,, In <br /> lbervy t t lee ste minirrA a&un statement Idenefred in 40 CFR 262.27(a)(if I am a targe quandty gemfato o }(,It. <br /> q.-ery genelalur)is true. <br /> Ge <br /> nyO / Month <br /> f]ay ear <br /> 0I \ / 0 <br /> J 16 nlemal na hipm <br /> F- ❑Impon fa U.S. ❑Expo-n from ll.S. Port of entrylexil', <br /> K— Transporn, nature(tor exports only) bate leaving US.. <br /> 1T.TranswrierAclmmutedgmml of Receipl of Malmals <br /> O TranspoRer I Pdnled/Iyped Names n AI /� Signature Month Oay Yearq <br /> a F` 1'S t,/1� ozi <br /> Z Tlanspoder 2 Prinledffyp oma Sgnatule Manlh Day YQaT <br /> / o ISO L"tS C O 8 Z <br /> }B.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑QuanWy ❑Typo ❑Residue ❑Panlal Relac6on ❑Full Ralacuon <br /> Manilost Relelence Number <br /> F <br /> 18h Aiiernate Facility{or Ganeralor) U S.EPA ID Number <br /> J <br /> V <br /> LL Facifilys Phone <br /> W 18c.Signature of Allennafe FBcilily(or Generator) Month Day Yea1 <br /> a <br /> Z <br /> H19.Hazardous Waste Report ManagamerM Mothod Codas(i.e.,codes for hazardous waste Irealment,d15p0U1,and recycling systems) <br /> a f 2 / 3, 4 <br /> 70.Designated Fad y Owner or Operator Cerlifirabon of rete hazardous malerials c red by the manifest sxc ss ndad m Item <br /> PrinterI ped Na 5Ignaku Month 08y y <br /> 1 - V:=— ,T <br /> EP F i1�4}_jWiouspy�'ffi4209' 269484 'YtIGNATED IAC1llSY TO GENERAT R <br /> JASON GAITAN, REHS Page 30 of 41 <br />