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Please print or g (12-pitch)typ 7�J 1806047549 SC: PPW 7/112,;21018 <br /> p type.(Form designed for use on eliteewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergercy Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 4 2 0 3 3 8 (800)483-3718 1011972885 F L E <br /> 5. enerator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ttracor I nc <br /> 2763 Boeing Way SAME <br /> Stockton,OA 95206 <br /> Generators Phone(2091983-3744 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Clean Harbors Environmental Services,Inc. MAD 0=3 9 3 2 2 2 5 0 <br /> 1.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Clean Harbors San Jose LLC <br /> 1021 Be <br /> rryessa,Road C: nvi5J9 49► 3iG <br /> San Jose,CA 95133 <br /> Facility's Phone: (40$1441-096 <br /> ga 9b.U S DOT Description(inducting Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No Type Quantity WLNoI. <br /> 13� 1 NON-RCRA HAZARDOUS WASTE,LIQUIDS,(DIPROPYLENE X48 <br /> GLYCOL MONOMETHYI ETHER) pig► Oijr <br /> a�q <br /> w �'Y <br /> z 2. <br /> w <br /> c7 <br /> 3. <br /> 4. <br /> 114.5 9ll3nndliingInstructionsandAdditionalInformation <br /> [[�!! }3 /)( TOT- <br /> Contract <br /> OTContract reta!ned by aener3tor confers acency auttlem'y on IrMat transooner to add or substitute addItIonall tra <br /> 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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement dentified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generaloes/Offeroes Printed/Typed Name Signature Month Day Year <br /> —J 16.International Shipments 112-1 &1162 <br /> Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit _ <br /> — Transporter signature(for exports only), Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> of <br /> z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 181b.Alternate Facility(or Generator) U.S EPA ID Number <br /> J_ <br /> U <br /> Q <br /> LL <br /> Facility's Phone: <br /> w 18c.Signature of A"ernate Facility(or Generator) Month Day Year <br /> F— <br /> Q <br /> Z <br /> CFn 7 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ 1' H141 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed Typed Name Sig e Month Day Year <br /> l lv <br /> EPA Form 8700-22Av.3-C h Pr vious editions are obsolete. d ������ED foILITY TO DESTINATION STATE(IF REQUIRED) <br /> Glean H ors h s the appropriate permits for and will accept the Waste the gene tDp <br />