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Slif SHIP# <br /> 6 7 7 6 0 0 7 5 K 3 <br /> Please print or type, Form Approved.OMB No.2050-0039 <br /> -r4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS I I Generator JD Number 2.Page]of 3-jrn�I N'no-Re7rge Iti <br /> WASTE MANIFEST 1006776007 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 9 199 At J.,-k' i <br /> - <br /> RIPON <br /> Generator's Phone: 209-5:99 79e 1 U.S.EPA ID Number <br /> 3-TTM 1000 B i P 0 5 <br /> ---'ISTEEKII-S INC <br /> 7 Transporter 2 Compti Name U.S.EPA 11)Number <br /> HAPROIRR FNVTPf-Y%1YJN7'RL SVC <br /> 8 Designated Facility Name and Site Address M FAN HARBORS FinN JOSE U.S.EPA ID Number <br /> 10-21 BERRYE99A ROOL' <br /> Facility's Phone 0 S--4 4 1--09fn'r-' SAN I ME COD059494:310 <br /> 9a 9b U.S.D07 Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers11 Total 12.unit 13,Waste Codes <br /> HM sort Packing Group(if any)) No. Type Quantity wt./Vol. <br /> I. WON-Rl HP.7ARDIDUS WASTE, El P <br /> "Olt- FILTERS) <br /> 3 <br /> 4 <br /> 14.Special Handling Instructions andAddil Information 7 C�F" S j <br /> P"-210 7 <br /> (10 <br /> H -'lip:R 710-10--zil--I"1-,101- SK'-1 Il --Cc-i t r tct t�i n e dl `1m g v n L r at b r- r P iii r e r c, eTi cy alut hor I <br /> or t <br /> tr,e.FSpor-terr� tQ &C.11d at' -kjh�titute ��ddil-liotrial t <br /> �BnSjoter5 un Die e.r a Or-,, tlui I f. <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION;I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled)placarded,and are in all respects in proper condition for transport according to applicable intematonal and national governmental regulations.If export shipment and lamthe Primary <br /> Exporter, cerfily that the contents of this consignment conform to the terms of the allached EPAAckno*ledgment of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)IN am a smi quantity general is true. <br /> GimeratcrslCfferors Printed/Typed Name Signature Month Day Year <br /> 10 1/jai aw AIR <br /> 16.Intelfiraficirial ShiprVts ❑ <br /> E.pert from U.S. Port of arril <br /> El I Port to U.S. <br /> Transporter signature(for exports only): Date leaving U.S.. <br /> LLJ <br /> 17 Transporter Acknowledgment of Receipt of Mai <br /> Month Day Year <br /> Tran P 'ed[T"'d Signature <br /> Signature Mofith Day <br /> yTransporter 2 Printed ame <br /> Year <br /> F <br /> 9 <br /> 18.Discrepancy <br /> 18a Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rel <br /> Manifest Reference Number <br /> 181b.Atemate Facility(or Generator) U.S.EPA ID Number <br /> Facility's Phone: Month Day Year <br /> 12 TI,1,9111111cma a Facility(or Generator) <br /> Z <br /> C.9— treatment,disposal,and recycling systems) <br /> 19 Hazardous Waste ep Management Method Codes h.e,codes for hazardous wast <br /> L 2. 4. <br /> Lot= <br /> 20 Designated Facility bwnerilfro atorCertfication if receipt h dous materials covered by the manifest except as Item I Be <br /> PrinitedfTyped Name Signature <br /> nth <br /> 0 E S e- <br /> El So�ff, 9,12-_1 evious edition are obsolete. DftIGMATED FACILITY TO E <br />