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C11?1.'37 Please print or type. (Form designed for use on elite (12 -Ditch) typewriter.) n117f�n271 AGP•Chni;:a f il7r1T1Q 9 Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsorete. DESIGNATED FACILITY ZO Dje'STINATION STATE (IF KEUUIKEu) Clean Harbors has the appropriate permts for and trout - --"`- --`e the generator is sMippirl [/ 10288.1492 UNIFORM HAZARDOUS 1 Generator ID Nu0mber 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST C A L 0 0 2 8 0 3 9 9 2 (800) 483-3718 001087956 F L E 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Target Stxe T-1526 280 Spreckels Ave Manteca , CA 95338 Generator's Phone: fjG R 9 QG ATTItI'Revp,"Se Logistics P Dee SOf 6. ransporter 1 Company erne U.S. EPA ID Number Clean Harbors Env;roflrrerta! Services Inc N1 A D 0 3 9 3 2 2 2 5 0 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number Clean Harbors San Jose LIC C A D 0 5 9 4 9 4 3 1 0 1021 Berryessa Road Sr, �h se_, CA 95133 Faai s one. r40.Q► tela-nQsl) 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12, Unit 13 Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt./Vol. Cr -1 Uit'1950,b�/ASTE AEROSOLS,2.1,NOtiE LIMITED QUANTITY 0001 343 X DOT -SP: 11396 0 0 1 D F 0 0 0 1 5 P LU -2 UN1993WASTE FLAMMABLE LIQUIDS, N.O.S.,(ISOPROPANOL, 0001 1343 X ALCOHOL DENATURED),3,PG II 0 0 1 D F I0 0 1 5 P 3UN3139.WASTc OXIDIZING LIQUID, N.O.S.,(HYDROGEN D001 135 X PEROXIDE),5.1,PG II 0 0 1 D F 3 0 0 1 0 P "RQ, UN3288.WASTE CORROSIVE LIQUID, BASIC, INORGANIC, D002 135 X N.O.S.,(SODIUM HYPOCHLORITE, SODIUM HYDROXIDE),8,PG II 0 0 1 D F 0 0 1 5 0 P (nnn2i 14. Special Handling Instructions and Additional Information 1. LCCRQ LP 1x30DP 3. LCCRO 1x50P 2. LCCRD 1 X50 4. LCCREI 1X300P WG#6J178MI FLEET4442105 LP#TARGET-D21 15. GEN ERATOR'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 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) (b) (if I am a small quantity generator) is true. eneratof es Printed/Typed Name -Ng na u Month Day Year vsa V, U 02 15 108 P- 16. International Shipments ❑ Import to U.S. Export from U.S. Port of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: LW 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month uay--7e—ar a Sean Spitzer 0 2 1 5 10 8 aTransporter 2 Pdnted/Typed Name Signature Doth ay ear H 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejedion Manifest Reference Number 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U Q LL Facilitys Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)ILLI 0 1 /11LF1 2. /�' 3. / lql 4 20, Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest a/xxceept as noted in Item 1 as Pr ntedrry Name Signatu Month Day Ye O / 5�1� o EPA Form 8700-22 (Rev. 3-05) Previous editions are obsorete. DESIGNATED FACILITY ZO Dje'STINATION STATE (IF KEUUIKEu) Clean Harbors has the appropriate permts for and trout - --"`- --`e the generator is sMippirl [/ 10288.1492