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7)3237314 5C PPW 0/2. _Ji0 <br />-- '--:-_ `-- ••-- -- _w,, ran .,a.a.k . ,a.,.3- Fnrm Annrnved. OMB No. 2050.0039 <br />.,,,...., <br />r,,,,, 1. Yr- ,,, I.- ,.,,,..y........,.--- <br />UNIFORM HATARDOUS <br />-.. -- - I -----I -��------- <br />D Nu be <br />1'exted 0 a� 0 0 2 9 3 <br />2. Paye 1 of <br />� <br />3. °mergercy Res gnse Phone <br />(800) 493VIBe <br />4. Manifest Tracking Number <br />0 0 0 0 68 0 7 4 M W 1 <br />WASTE MANIFEST <br />5. - ra r' lam d li Ad res, Generator's SlteAddress (if different than mailing address) <br />drin �°'�i�or l�ka 1� �r0 ucts <br />26700 South Banta Road SAME <br />Tracy. CA 95376 <br />Generalar's Phone: (2091635-5424 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />Clean Harbors Environmental Services Inc MAO 0 3 9 3 2 2 2 5 0 <br />7, 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 EI Dorado LLC ARD 0 6 9 7 4 81 9 2 <br />309 American Circle <br />El Dorado. AR 71730 <br />Facility's Phone: (8701663-7173 <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />1. UN3262. CORROSIVE SOLID. BASIC. INORGANIC. KOS_ <br />L81 <br />0 <br />� <br />X <br />(SODIUM HYDROXIDE), 8, PG 111- <br />i% <br />J <br />Z <br />2. <br />w <br />3. <br />4. <br />14, Special Handling Instructions and Adgiitonal Informafion <br />_CHa7�456I i }GSS.BP EPw#.25g <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 rational 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 EPAAcImowledgment of Consent. <br />I certify that the waste minimization statement idenfified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generator's/ tferoI's Printedrfyped Name SignaluJ� Month Day Year <br />' <br />, . f2 (�k � L� <br />K- <br />16. International Shipments <br />❑ Import to U.S. ❑ Export from U.S. Port of entrylexit <br />= <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />17. TransporterAcknowledgmerit of Rece0t of Materials <br />K <br />O <br />y <br />Transporter 1 PrintedlTy ed e/ Signahrr Month Day Year <br />��A - � r I � I ) <br />"tel �� " t -2 -Alf <br />za <br />Transporter 2 Printedrryped Name Signature Month Day Year <br />18. Discrepancy <br />�� �� <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue LJ Partial Rejection ❑ Full Rejection <br />Mardfesl Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number I <br />J <br />U <br />ui. <br />Facility's Phone, <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />a <br />Z <br />N19. <br />Hazardous Waste Report Management Method Codes p.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1 M040 <br />2. <br />3. <br />4. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br />Printecirryped Name Signature Month Day Year <br />FPA ForM HIUU-22 (FOV. 3-0b) HrevioUs eartions areoosolete. ;Jk ,5lUI14A I t'tl I 'a.:1l.I I y I ra IJC;, I INPI t Iv1V ;' I ra I r- t!r r r-Gr.crrn _:"I <br />