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IeanHarbor Certificate of Disposal / Treatment - Storage and Transfer Run Date:5/10/2017 <br /> Manifested To Site: San Jose, CA Facility <br /> 1021 Berryessa Road <br /> San Jose, CA 95133 <br /> EPA ID/Prov ID: CAD059494310 <br /> Generator ID Manifest No. Generation Date Received Date <br /> QU21660 08-016-00639 4/24/2017 5/1/2017 <br /> The above described waste, received at the Clean Harbors facility listed above pursuant to the manifest(s)listed above, has/will be treated and/or disposed of by Clean <br /> Harbors,or another licensed facility approved by Clean Harbors, in accordance with applicable federal,state and provincial laws and regulations. Any waste received by <br /> Clean Harbors and subsequently shipped to another licensed facility has been or shall be identified as being generated by Clean Harbors in accordance with 40CFR 264.71(c). <br /> For waste imported/exported to/from Canada the waste has/will be disposed or recycled according to the Canadian export and import of hazardous waste or hazardous <br /> recyclable material regulation as published in the Canadian Gazette Part 11,vol 139, No 11,SOR12005-149 May 17,2005 <br /> Under civil and criminal penalties of law for the making of submission of false or fraudulent statements or representations(18 U.S.C. 1001 and 15 U.S.C.2615), 1 certify <br /> that the information contained in or accompanying this document is true,accurate,and complete.As to the identified section(s)of this document for which I cannot <br /> personally verify truth and accuracy,I certify as the company official having supervisory responsibility for the persons who,acting under my direct instructions, made <br /> the verification that this information is <br /> true,accurate,and complete. <br /> Signed: /<2,e 9-"); �- Date: 5/10/2017 <br /> Title: Director Facility Applications <br />