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SBL -.1HIP# 226489753 <br /> Please pint or.type.(Porto designed'for rise g'16.11 p(fch)typewrites) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS. 1.Generator ID Number• A 2:P ge of mer Res o e Pho e 4,"ani est ra in Nyp�b�L ^ <br /> CAR@3I70 -rte- 1 r` td 4 J 9 1 Q U <br /> WASTE MANIFEST - SKS <br /> Generators Name and Mailing Address Generators Site Address(If different than mailing address) <br /> Cscalan Preil i" Brands �Iric <br /> 19M Mchenry Rvfif <br /> Generators Phone: N9_552-605 1 <br /> 6.T�t Cortlf>en rpe SYSTE I� U.S.EPA ID Number „X 1205 <br /> T CsL. nl - <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> (.3-FRAN HARBORS ENVIRtlW"TAL SVC IWC. MAN1393122258 <br /> 8.Designated Facility Name and Site Addiess 1 HARBORS SAN JOSE US.EPA ID Number <br /> Net BERRYESSA ROAD . <br /> SFVJQ 9 fw'r5 95133 <br /> 4ea X41-6 ► l .�,. ` CAMS- 49431 <br /> AMS- 494310. <br /> FacilitysPh60e:, •'.,, 1 , I r`:w <br /> 9.a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM a%aycldng Group(d any)) No Quantity WtNoit <br /> rRA HRZRRDM TE . SOLIDS P 141 <br /> , r <br /> o i II�"1'tJA 2TABISUL ITEa, <br /> LU 2. <br /> F7IFF M n f;n., <br /> s. Iu <br /> IOCT 0 n' <br /> By <br /> Special Handling Instructions and Additional Information TSD SJ 77808962 tJ(, Cgs: <br /> 24t-! QERGCNGY B"-458 176@ t l/91t/:.TFl-Canti^act .re nod by ger terat or cors`�e. y stt hiar..i <br /> on-initial trans orver to acid or; substitute additr.dnal �r;1115 snort on enera c, <br /> on Wh��i�:'.y <br /> 15. GEMRATOR'SrOFFEROR'S CERTIFICATION:I hereby declare thsf the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified;packaged, <br /> mar : . <br /> ked and(abeledlplacarded,and are.in all respects in propercond�tin ifor�tpo�a we to ing applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment confAnVoo'ihe terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in,40 CFR 262.27(a)(if lain a large quantity generator)orSb1(f I.ailt a small quantity generator)Js true. <br /> Generatdrs/Offeroes Printedrryped Name Signature. <br /> ( Month Day Year <br /> A\�� ?��!`X i1+�v�, :�::asai�. i r K "�' ✓r• �; ��'f n ( 7 ! <br /> -.r 16.Intemafieri l Shipments ,j� <br /> F- El Import ZO•U y$. ty Export from U.S. Por}ofentrylent <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> WL 17.Transporter Acknowledgment of Receipt of Ma(enalsw` Y "' <br /> oTrans grter 1 Printedrryped Name Sig a Mon .Day Year <br /> EL f <br /> QTrenspbrter 2 Prin ame' Signature Month Day Year <br /> 18.Discrepancy'• <br /> 18a.Discrepancy Indication Space E quantity r ❑Type Residue ❑Partial Rejection Full Rejection <br /> i•.i• �� I,.1�•ir,st"Uiti:�il ManlfestReference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> .J Q <br /> V - <br /> 11 Fadlitys Phone: , <br /> 82 18d.Signature of Alternate Facility-(or Generator) Month Day 'Year <br /> Hazarddus Waste Report Management Method Cokes(i.e.,codesfor hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3 14. <br /> I <br /> 20.Designated Facility Owner or Operator.Certification of rece pbof hazardods materials gverdd by the manifest excep .noted lnjdm jOh ' <br /> :7 <br /> PrimWyped e Signature Month Day . Year <br /> EPA Forth 8700-22(Rev.3-01 6) Previous editions a obsolete. D. (GNAT D FACILITY�04t ERATOR <br /> i)84168ID4f 170071 �: <br />