COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

SK SHIP# EA9582iiII 12 007767761 SKS Please print or type. Form Approved.OMB No.2050-0039 1.Generator ID Number 2.P 0 3. mef enp R n e P UNIFORM HAZARDOUS �. 4 :..Y .eSPq s..doneManifest roNumber WASTE MANIFEST t J 1 0071%7761 SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) c' # 1i2: Soul f=,'Dnt Street- We St Lr; tial-ry,;.p.(Tr_• TN 38103-0000 Generators Phone: Pon-`357-1108 CA 95210-32148 6.Transporter 1 Company Name T-- U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number il�1 c-t-✓ He,rh&rS 5 Ve- 011 ZLtS� 8.Designated Facility Name and Site Address LEAN HAF". . SAN JOSE U.S.EPA ID Number 1OZ-21 BERWIL:; A ROAD SAN JOSE CA 95 133 t08--441-07,1u` CAD05949'f 310 Facility's Phone: 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. P� Lich i q':33 SIRS 1 E F"LAI`I ifli' :+LE t-I D:I I L';_ 01 FOOL F1.�.`O : o N°b.S. , (X�LENEE, BENZENE), 3, PG I1 Z 2. UJ c9 3. 4. 14.Special Handling Instructions and Additional Information a T ch1 \ O -4H EMERG�NCY>�A00--468--1760-CH/SK/TFI-•Contract retai �y pner•j cc��er s r�e��y auxr, ..n •� z _. i i-,^ 'C':r•,.`4-G r` t".. -�j r! q j, fi11•+. }•i4 �•4 ` � �,F - 1-_`.;a T,, 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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and natio I governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Cons t. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantityg rator)is true. Generatgr's/Offef�Printed/Typed Name Sign Mores Day 16.International Shipments I `J(f^ F- ❑Import to U.S. ❑ it from U.S. ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Tr p iter 1 Printed/Ty Name Signatur Mo Da r O a- Z Transporter 2 P nted[Typed Name Sign ure Month Day Year 103 10Z, Z 18.Discrepancy 188.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial ❑ yp lection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z u, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of h zardous materials covered by the manifest excep;4p noted in Item Pdnted/Typed me Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolet DESI ATED LITY TO PA's e-MANIFEST SYSTEM