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Please ow 9 m at:knowledge' that no material change has occurred ether In the <br />N... ---Y PaniTiftft. OMB No. 2050-0039 A UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />5. Generator's Name <br />11. GeberaMr ID Number <br />AD 98 188 8344 <br />I 2. Page 1 of <br />1 <br />I 3. Emergenc-y Response Phone 14. <br />(300) 483-3718 <br />Mandeit Tracking Number <br />015447563 FLE and MaAing Address Geier-aloes Site Address (f different than mailing address) Pacific Gas a Electric co - McDonald Island Comp <br />Pacific Gas ft Electric Co- Manifests PO Box 7640 McDonald Island Como Station 2121.14 Zuckerm San Francisoo CA 94120 Generaior's mone19251852-11362 ATM-Rabb Roberts 06 I Stodann.CA 952 <br />Transporter 1 Company Name <br />US. EPA ID Ncynber <br />Clean Harbors Environmental Services. Inc. <br />Transporter 2 Company I MAD0393292 Name 50 U.S. EPA ID Number <br />B. Designated Factirty Rana ad Site Address ,I <br />San Facility's <br />Clean <br />1021 <br />U.S. EPA ID Nurnber <br />Harbors San Jose LLC <br />berrvessa Road CA1)0594942 10 lose. CA 95133 Phone: anal LiLt11962 I ga <br />HM <br />Sta. U.S. DOT Desatiption Rade:tog Proper SNpping Name, Hazard Class 10 Number, <br />and Paelthll GlouP 1d aflY0 10 Containers 11. Total 12. Umi <br />No. Type Quantity Wt./Vol. 13. Waste Codes <br />o .4 <br />1 <br />NON-RCRA HAZARDOUS WASTE. UQUIDS. (OIL. WATEFf) <br />07 DM IWO ig 3 m z 2. 'toy f' to 0 <br />3. <br />4. <br />Sathiand114181ructions ;:t. and Additional Information <br />1-f 60: 559 8' 1 -- 55 PM <br />retained bY .Contract QcnetatOt onillerS arteficl . ._ . ......... 15 GENERATOR-SIDEFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment a-e ftily ard accurately desaibed above by the proper shtiping name, are .,... • . .. • .. ,-. marked and la baled/placarded ald are in al respects in proper rendition for transport according to appiceble international and national governmental rsgulations. It export shOnent and Ian the Primary <br />Exporter, I certify that the contents of this consignment conform la the terns of the attached EPA Acknowledgment of Consent. <br />I certify that the waste miranizatice statement Identified M 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a smal quantity generator) Is hue. <br />1' <br />GeneratortiOfferoes Printed/Typed Name Sigrtalrjre Month Day Year <br />)45-tjarlb.i <br />1 <br />I it ,, Intemational Shipments l'3 1 r— <br />F... <br />ill Irroxel to U.S. II Export horn . . Pori of entry/exit Transporter stiplatt-tra (for exPoris 004): Date leaning US.: p5 <br />P <br />17. TransporterAcknowtedgment of Receipt of Materials <br />Transporter I Printed/Typed re R <br />Name <br />*more Month Day Year Dt- ar e— A 0 I AL.- It 1111,731.21 1 Transporter 2 Printiadayped Noire <br />S J ignat'n <br />Month Day Year <br />Iii18. Discrepancy 1, <br />L 18b. <br />18a. Discrepancy Indication Space . ca,analy III Type III Residue M P <br />Alternate Facility Maarlest Reference Number:Pa-theRejection <br /> II Fat Rejection <br />_I <br />0 < u. <br />2 18c. <br />for Generator) <br />U.S. EPA ID Number <br />Facittys Phone: <br />Signatire of Alternate Faddy 1 ,P <br />2 <br />2 19. <br />(a Generator) <br />Hazardous <br />1 Month Clay Year <br />I I co Waste Report Management Method Codes (i.e., codes for hazarcbus waste treatment. disposal, and recycling systems) to 1. <br />° H141 12. 13. 1 4 <br />I 20. Designated Pacify Owner or Operator Certkation of receipt of hazardous materials covered by the manifest ex .., acted in Bern 1 Eta Priratitame426, z., , Signature ), 607-":"4.6") Month Day A <br />PA F8709-222_2ev. i..... 1/2.13 12-1..)7 PreViOUS editions we obsolete. —• - - • - --- - e peones ix vie vise vie mai me generator is TO EPA's e-MANIFEST SYSTEM <br />712005830754 PPW