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Please print or type.(Form designed for use on elite 12-pitch) -writer.) 7/9665804 SC PPW i' ./2013 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Numt er 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAI-0000i3863 S (800)4833718 007582473 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Stockton USD-Edison HS 1944 N.El Pinal Drive 1425 South renter St Stockton,CA 95205 Stockton,CA 95206 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Clean Harbors Environmental Services Inc MAD 0 3 9 3 2 2 2 5 0 7.Transporter 2 Company Name MrAiLms V L1111111111600U.S.EPA ID Number 8.Designated Facility Name and Site AddressU.S.EPA ID Number Clean Harbors Aragonite LLC M'AY �� 20 11600 North Antus Road U T D 9 81 5 5 21 7 7 Facility'sPht�lle.UT 8�435158481Oo ENVIRON029 MENTAL ga 9b.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 W1Nol. 1. UN1263,WASTE PAINT,3 PG II 212 213 341 o 11 r OF 15 343 DOO1 D003 w Z 2. w t� 3. 4. 14.Special Handling Instructions and Additional Info m on 1_CH?79039 ' E 128 l lM MAW ?� Sd 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 labeledlplacarded,and are in all respeto proper condition for transport according to applicable intemabonal and national governmental regulations.if export shipment and I am the Primary Exporter,I certify that the contents of this consigna ent conform to the terms of the attached EPAAcknowledgment of Consent. ` I certify that the waste minimization statement iden ified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We. GeneratoeslO(feror's Printed7Typed Name Signat11on ay Year 41 .A 16. n emational Shipments 1— ❑Import to U. . ❑Export from . . Port of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials ^ Transporter 1 Phmedrryped ame ignalureMonth Day Year 0) At:Tw z I ISI // I / QTransporter 2 Printedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection E]Full Rejection Manifest Reference Number: 18b.Atemate Facility(or Generator) U.S.EPA ID Number J U a w Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z cnFn 19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1- H14i 2. 3: 4. 20.Designated Facility Owner or Operator:Certification o receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are o solete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) Clean Harbors has the appropriat permits for and whl accept the waste the generator is shipping.