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SSL. SK SHIP**P73y� y <br /> Please'print Wl or type. <br /> Form Approved.OMB Na 20.50-0039; <br /> j UNIFORM HUARDOUS 1.Ganeralar ID Number 2.Pag 1" 3. m p 4.NanifeM1..ld�`Nuu�mber Q SKS WASTE MANIFEST CAL0�B393232 el — 1./bib 0 0 7 7 V 91.1 V SRS <br /> 5.GerterabYs Name and Mal Address � Genaramrs Site Address d drWent Man mailing address} <br /> O'Reilly 0 458 f g <br /> 1 .N Tracy' Blvd <br /> V <br /> T CA 95376-3435 <br /> carierapors Pnone: 97�-555-1554 <br /> .. U.S.EPA Number <br /> �- S'ISTEMS INC T%R""81M <br /> T Transporter2 an Hama U.S.EPA IO Number <br /> j CLEFRlR6 EM SVC INC. MAD0393�30 <br /> B.Desigda(ed Facility Name and Silo Address CLEAN.WMRS SAN JOSE U.S.EPA ID Number - <br /> 1021 BERRYESSA ROAD <br /> 408-441•-A�3 2 <br /> SW JOSE , CA 95133 CAM9494310 I <br /> i Fa ilitps Phone: <br /> ga. 8h.U.S.OOT 1)4pficn(including Proper SnippIng Name:Hazard Class,IU Number, 70.Cmlaircem - I <br /> i 1T.T"al 12.Unit 13.Waste Codes <br /> .HM <br /> and Padang GmuO lg any)) - -- No. Type Ouant4 WIN". <br /> % 1. RQ UN1993 WASTE FLAMMABLE LIQUIDS Dol P <br /> o N.b G., (PLEMS, BENZENE), 3, PG 11 2�© ;'N1i F0W EE03 <br /> as (Dur) PW DWI 223 <br /> W <br /> LLS <br /> 2, <br /> 49 <br /> I <br /> 3 I <br /> S <br /> 4 A i <br /> 1 _ <br /> 14,Spedal Hamlting lnelrul igns;and Aedldonal,lnfomlaton -TSD'i SJ M18211 OR.14,t;i CSB; <br /> tel'LI'J�p <br /> 24h4 Eh-W.ICY#SW4GB-17?=/SK/`T'EI-antract rrltainwd by genfratnr Cunfors .sgarlcy suthnri y .1 <br /> an initial tr ns art r:to add or auh uta.additiatl 1 train ort r n an r2ti r* lf. <br /> -95. GENERATORMMFFEROWSCEMVICATM0 I hereby declare that the wntenls ofthis oonsgnmsnt are fully and amialely described above by Me proper shipping name.and are classified:packagsd, <br /> marked and Udediplacanied,and are in ail respects in proper oerrdifion fortransport a000rding to applicable inkrnalianaland nalinrnal governmental regulators.Report shomentand I am the Primary _ <br /> -Exporter,lcadihjMat thecontenipofthisoonsigmnemmntmothtie termsoftheattached EPAAclmowl pwrtofCarnserd. <br /> I ce*that the waste mi kruation stalamenl identified in 44 CFR 262.27(a)(if I mm a large quan42y gerrerataQ dr(b)(BI am'e smal quay tygemtor)is True. j <br /> Garr- <br /> Meg PdlCTyped Name - Signature - M Day Year � <br /> J 16.Irde- al5hipmenls - ! <br /> 2 - ❑ to U.S. ❑Export firm .. - Poli dantryledt <br /> .y Transpoto s' foreiP %a*): Date leanngU.S.: <br /> W 1T Tm bMftFi-aReoeiAofMathrrals <br /> lllsrr Po R -Name - 5gnefise00, M JO - Year <br /> Trmisparter n Ypedme - - Sig re <br /> Month Day Year <br /> 1.Dlacrapanoy - - - <br /> 78e.Oiame}7anry IndiCetron Space ❑Qusnlily ❑Type ❑Residue ❑Partial Rejection ❑Fr41 Rejecfian <br /> Manliest Reference-Number, <br /> 18b.Altsmaui Facility(or Generator) - - <br /> -U.S.EPA i EO Number - <br /> J <br /> v <br /> Fadirys Phone: - - <br /> 18C,Sgramm ofAtemate Faclt'ty(or GenerEgr) - - - Mnrdh Day Year <br /> Q <br /> Z <br /> W19."seardotra 448619 Report Management Method Codes(.e.,ondes for hazardous waste healms%disposal,and recycling sysbms) - - <br /> i. H141 2, 3. - 4. <br /> 20.Designaled Fsclkty.Owrrer or Operator Cerhfiratim of fol ofhazwdous materials covered by the manifest except as in Ilam 18a <br /> PMWTymdww '� -' Signature / Mond yaar, <br /> 06 <br /> EPA F r72 <br /> 943/.8 v. 43i 17 Previoussdi6onsareohsdete. DE51GN DFACILJTYTUGENERATOR <br /> 1') <br />