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2763 Boeing Way, Stockton Record ID PR0542371 <br /> 3/18/2019 <br /> Photo 2: Manifest number 011972885FLE (date unknown)was found without a signature from the TSDF. <br /> qr _(4am des road forum on elileh&ill tar.11906047549 SCPPW 7(.12!26113 <br /> NAZARDOUS Generara ID Number 2.Pa9-11(.F,mpgei y Reponse d.yaag„,r p er.�No 2''54 <br /> ,�tt MMIFgsT CAL 00 04 20 33 9 1 900}483-3:18 7 F1[ <br /> end Address Genu a-9de n1 nWpn-address! C <br /> r roc <br /> 276880efng Way SAME <br /> s,okton,CA 95206 <br /> s pie(2091993-374-4 <br /> 1 oro r, - US.EPAIDIMber - <br /> Clean Harbors Environmental Services,Ina M AD 0 3 9.3 2 2 z 5 n <br /> .TranspMar 2 CompenY Name U.S.EPA ID Nunber <br /> - red oldyNgreardSillress U.S.EPA ID Nmlber --' <br /> Clean Harbors San Jose LLC <br /> l- 10219eMessaRoad CAD059494310 <br /> San Jose.CA 95133 8} <br /> Fedklys PhOl <br /> Sa go.US,00TOesalpfion Inducing Proper Shipping Name.Hazard Class,10 Number, 10.Containers it Total 12.UM <br /> HM aM Pacldrg Group('any)) <br /> No- Type 0uanfity W1yyq_ 13,Wash Codes <br /> r 1NON-RCRAHAZARDOUS WASTE.LIQUIDS,(DI PROPYLEN E <br /> W GLYCOL MONOMETHYL ETHER) �/If 4 <br /> a4 Y' <br /> it I <br /> r 4. <br /> r 14.5 IHandlin InsWo6o/n5 antl Addieonel Informalr <br /> 14375 7 !X TOT <br /> contract retained by Generator Gorlrers aoencn awhomr on 1n!tlal tlansooaef to add or EubstRme adD IG I <br /> 15. GENERATOWSIOFFERI CERTIFICATION:I hereby declare that the contents of this consignment are(ally and accurately dealabove by the proper shipping name classified,and are padm*, <br /> marked and I.Imedtplacamed,and are In all raspecls in proper condition for transport socordmg 10 apW cable normal and national governmental regulations.If export shipment and I am he Primary Q <br /> r Expadl I certify Mat the contents of this consignment conform to the tarots of the adzchad EPAAcknnwledgment of Consent <br /> I oardly that the wash minimvafion statement identified in 40 CFR 261(11 am a large quanfiy generator)or(b)if l am a small quantity ganarztar)is true. <br /> anamtses/Offeal Porteniffyped Nae /\) Signature s n y e <br /> 0, ova zya4-16.International Shipments <br /> i— EI Import to U.S. ❑Export from U.S. Pat ofenhy/exiC <br /> = Trans rtersr nature Iforexports only): Date fiel U.S.: <br /> w17.TransporterAckrmwledgment of RaceiptofMatenals <br /> t so Transporter 1 PdntaNryped Name Signature ay Y. <br /> /4 e1w <br /> QTranspoder2 Primed/Typed Name Signature Monts ay e <br /> ✓ K <br /> r- <br /> 18.Disaap", <br /> ✓ i 1Be.Discrepancy Indication Space ❑ leCggn <br /> ❑Quantity ❑Type ❑Residue Panel Rejection FUII Re <br /> 4 <br /> Manifest Reference Number. <br /> 18b.Altemas,Facility(or Generator) U.S.EPA ID Number <br /> r � <br /> V <br /> LL Fadli sPhane: <br /> I 18c.Signature ofAMmate Factiy,for General Month Day W <br /> 4 <br /> 2 <br /> W19.Hazardous Wash Report Management Method Codes(i.e.,erodes for hazardous waste trealmenl,disposal,and recycling systems) <br /> r 0 1. N141 <br /> 1 20.Des gnaled Facility Ownet a Operator.Certfcafion of receipl of hazardous materials covered by the manifest except as noted in Item 1 B <br /> k / PrinledrT1P.NameSgnaWre Month my Ye <br /> 1F" <br /> 'r EPA 1`01%,,00-2211iIDOfs h�5 illy!dDDUS ilion !!DlRt1115 fOf 8114 WIII lCClpt its!N35[!fh!E1111A[jEC1s311NDF4ILITY TO DESTINATION STATE(IF REQUIRI <br /> r <br /> t t <br /> John Alaniz, REHS Page 2 of 3 <br />