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K• ma�yy.// n �-II.Ff forvse (�2 )tYPpr') Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 GieOa�ID Number ,' C a 2.�igej 0 3.Emerge�l� sAopse Phop 4.Manifest Tra in Nu b WASTE MANIFEST �CARti'+1�003937® Y—r m�r�latl-'1l�� }n� xA SKS Generators Name and Ma&W Address 0 6 � "4 V E st=a l on Premier Brant I Generator's Site Address(d different than mailing address) nc 190S" M-henry Ave ESCALONI CA 95,1-9&01 Generators Phone: —55 —G051 a SYSINC- V 1IS'.tEPA ID Number n nr^T `� ZC�13 U 1'xRl@1. 1e"'�5 7.Transporter 2 Company Name U CLEAN HARBORS ENVIRWENfAL SVC INC. U.S. ID Number 8.Designated Fac+iftyName and Site Address CLnN HARBORS SBy . . PAID Number 1021 BERRYESSA ROAD Cf1 95133 408-441-09 B Faays Phone- - f C00159494310 10 9a. 9b.U.&DOT Description(including Prope'r . Shipping Name,Hazard Class,ID Number, 10.Containers HM and Padang Group(d any)) 11.Total 12.Unit 13.Waste Codes No. Quantity WL/Vol:,. oX 1' LINM84 (.'(?ST,E CORROSIVE-LIQUID ACIDIC ��R 141 �I�N,�OyR�bwac m O,S!, (NITRIC AID 44ua-rrrkiC GID) 8, p(3- II ' ! -?DV ?k. rl, z3TE c M lk4 HYDROXIDE �� P ` SQLUTIbi Q, Pt 11 D��t' 141 ' 4 • +� 'CRA HAZARMms TE SOLIDS, DM tf 9S� Er,ITS Gt7N1TRMINATF� WITH L�IL), jltr- 1Q� P WJN—RCRA HAZARD" WA �LI.D$, P �S� (C EAfNING CGNPOU tD), l :�"''� ter'" Special Handling InstruCn=and Additional Information r � TSD: 77988962 E51 15 C58� f, f I f 1)ERG#154 2)E"r4415 t �"E � �� 241-1 EMERGENC't'.tir.a0-459-17GW-CN15Ki`iFIY-C,pta� act re�aifl�d tl , getterator�I ers � ertcy a�sAi�t7r�i �. on initial transoarte►� td-add or substitute additional transporters on oenera oris 'phis . 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I fierelWdeblafe that the ibcintents of this consrgnment are fully and"accurately described above by the pr"oyer shipping name,and are classified,packaged; marked and labeled/placarded,and are in all respects in proper conditionfor trans rt accoNjn to a liable intematio al and national ovemmental regulations.If export shipment and I am the Prima i transport a r' g i ppr•r, a n 9 9 P P Primary Exporter,I certify that the contents of this consignment conform to the[erns of the attached EPAAckhbWedgment of Consent I certify that the✓caste minimization statement identified in 40 CFR 26227(a)(d i am a large'quantity generator)or(b)(if I am a small quantity generator)is true. Gene OfferorsPrintedlTyped Name "t t.Urtl♦ Signatu f, Month Da �.� r r.ir , J7i v I i y Year I'� 4��v Li � �V!�.�.•��r•a; ' r.., t .i i::.�� re: ��ri l:d- V. --r 16.Intem rtional Shipmerrfs r—� A z LFlmp rt to FU.S. r. 0 Fx�ort from U.S.�. i t, 1,1 Port 0 ntry/exit, . Transporter SOL.afure(for exporfs only): Date leaving U.S.: " W 17.Transporter Adajowtedgrpwt of Receipt of Materials' • s�n Ms►t o r r r c c ., 0 T 1 Printed/Fyped Name Sig at Mo th. Day Year M Q Ira porfer2 Printed/li_./Name 'Signature Month Day Year ! { 18.DiSaepancy 18a.Dlscmpanry Indkxtjon Space 1j Quantity. ❑Type , Residue Partial Rejection Full Reject on Manifest ReferenceNumtier. 18b.Afiemate FaaTrty(or Generator) U.S.EPA ID Number J U Fadi itys Phone: •' hi+o w' 18c.Signature ofAltemate Facility(or Generator) Month' Day Year a Hazarrious Waste Report Management Method Codes(i.e.,codes for azardaus waste freatmerlf,dis sal,and recycling s tams P 9 ( h FP. ys . ) 2. 4. 26,Designated Facility er or Operator.Certification of receipt of h ous jnaladals covered by the'manifest except ,nded 1 it 1 PdntedlFyped me 1 Signature ! 0Month D 'Ye r EPA Fo 8700_-2_2IIRev.3-05 Previous editio s are ob ek�ee ED FACILI TO GENERATOR 1)8 17520/170 0 2 )FJ417�> lI7> ; '8�144124`��'1.^ic^8-f' 4f,A416L /Q