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{ Please print or type. Farm designed for use on afte(12-pitch typewriter.) 615066609-002 SC PPW 3/3/2011 1.Generator ID Number Form Approved.OM B No.2050-0039 UNIFORM HAZARDOUS 2,Page 1 of 3,Emergency Response Phone 4 nifoat cackle N'7964 mb WASTE MANIFEST G A v 9 8 fi 4 s o 2 3 :�2 1 (900)4S3�T19 6 0 91 j 7 9 0 4 F .E 5.Generator's Name and Wling Address Generaloda Site Address(If different than mafling address! University Of The Pacific g .3601 Pacific Avenue SAME Staten.CA 95211 Ganeretar s phone, $91E 846.7645 6.Transposer 1 Company Name Clean Harbors Erlirirortmental SprviceS lac U.S.EPA ID Number iWADO39322250 7.Transporter 2 Company Nama U.S,EPA ID Number r ' 6.Designated Faogily Name and Site Address o r U.S.EPA ID Number Clean Harbors San Jase LLC #021Ansa Rand SAN JOAQUIN COUNTY CAD 0 SanJase.CA 5 9 4 9 4 310 € se. 85133 ENVIRONMENTAL Faciiiii a Phone: f40Si 441-0962 ga, 91),U.S.DOT Description('srcl�ng Proper Shipping Name,Hazard Class,ID Number, �gconta�iners' HM and Packing Group(if arty)) 11.Total 12"Unu 13.Taste Cedes Type Quantity WLNOI. c 1" RD.UN1993.WASTE FLAMMABLE LIQUIDS.N.Q-S.. 234 D001 11036 r- x 04EfHANOL.ACETONITRILE).3.P011(0003.1 001 O F 00005 . G _ F002 I F003 F005 2' RQ.UN1493.WASTESILVERNITRATESOLUT10N.5.1.PG11 G 331' D001 (13001. 0011 D0111 0 01 D F 0 0$0 5 3- RQ.UN2909.WASTE MERCURY.B.PG 1110009) 3 41 DOGS X 003. DF 00012 P 4' NOR RCRA HAZARDOUS WASTESOLIDS.(SOIL.ANTIFREEZEI 002 D F 00760 " P 191 � 14.Speraal Handling Instructierrs e;dAddilionai Information 1_CH582268 ER 12e 3X5 2.CH588428 ERCG#14D 13{5 2.LCHG2 HRG#172 ]X5 ` 4.CH617265 2X20 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully arid accurately described above by the proper shipping name,'and are classified,packaged, marked and labatedfplecarded,and are In all respects in proper condition for transport sccording to applicable iniamational and na8onal governmental regulations"if exporl shirmentand I am the Primary i Exporter,f certify that the contents of this consignment conform to theterms of the attached EPAAcknowladgment of Consent. I eedify that the waste minimization stalemsnt IdantiMed In 40 CPR 262.27(a)rf I am a large quantity generator)or(b)(If i am a small quantity generator)is true. e (atof Otlerars rim ed ypetl erne . biignm re ion ear DEAV G L I+C IF I C 1 03112 1 13 ij 16,;'qternatimal Shipments ❑Impos to U.S. Expos from U.S. Port of entrylexit Transporter signature ffor a ds.onU: Data leaving U,S.: w 17.TransporlarAcknowfedgment of Receipt of Materials ER Tren5POftT 1 PnntedlTypod Name gna re ay ear a MIKE BRUNYANSKY (n 03 12 13 Z a Transporter 2 Pdniedffyped Name Signature MorM Day ear LLQ " N 18.Discrepancy 18a,Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejeotk. ❑FuII Rejection Manifest Reference Number. 18b.Alternate Fadfity(or Generator) U.S.EPA ID Number [s " Faa1i s Phone: 18c.5EgnatureofAlternateFacility(orGenarator) Month Day Year z L5. 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treabnent,disposal,and recycling systems) H141 a H070 3• H141 =N114:1 R 20.Designated Fe My Owner or Operator.GWi6catlon of receipt of hazardous materials covered by the manifest except as noted in Item 18a NntedfTyped Name Signature Month- .Day Year EPA Form 8700-22(Rev.3.05) Previous editions are obsolete- DESIG MATED FACILITY TO DESTINATION STATE(IF REQUIRED) clean Harbors has the appropriate permits for and Will aseept the waste the generator is shlool!"A.