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Generator acknowledges that no materlal change has occurred either In the cn3racter,0cs or In the process generating the material. Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number PEm age f 3. ergency Response Phone 4.Manifest Tnckdng Number WASTE MANIFEST CAR 0 0 0 2 2 5 5 5 7 1 (800)4833719 1014694502 FLE 5. s N and Mailing Address Generators Site Address(d different Ihan mailing address) Meigg J'K Inc .7 ti a 105)0 RGZ A;2 i535 r.rescaiiero Ave. Overland Fork K5 b'6211 Tracy,CA 95304 Generartl Phone:( 0 ATTNAamie Haines 6,Transporter 1 Company Name U.S.EPA ID Number Clean Harbors Environmental Services,Inc. IMAD039322250 T Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number Clean Harbors San lase LLC CAD 0 5 9 4 9 4 3 10 1021 Berrvessa Road San lose,CA 95133 Faality's Phone: 9a. 9b-U .DOT Description(inckfdirg Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12,Unit 13.Waste Codes HM and packing Group(If any)) No. Type Ovantity Wuvol. rr UN1219.WASTE ISOPROPANOL,3.PG II n D001 1331 W 2'NA3077.HAZARDQUS WASTE.SOLID.N.O.S..(LEADI.9.PG III X oa 1 D F D009 352 b5�' P 3 NON-RCRA HAZARDOUS WASTE,SOLID,OSOPROPANOI 352 ABSORBENTS AND PPE CLEANUP) 0 9 Q b0 4.NON-RCRA HAZARDOUS WASTE,SOLID,(CLEAR TOP GLAZE p 352 ABSORBENT AND PPE) 14.S�u rel handl Instructions and AddibonalInformation I- 2017�1TST 9129 2_Ca201710e,yi &�Gi171 C ��• '7b 2� 3_CH2017500 Z x 44 FCgH ract retained by Qeneraior conifers agency uthorMv on ril�0 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and amxately described above by the proper shipping name,and are dasshied,packaged, marked and iabeledlplacarded,and are in all respects In proper condition for transport according to applicable intemational and national govemmental regulations-If export shipment and I am the Primary Expoler,I certify Cwt the contents of this consignment conform to the arms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(ill am a small quantityorator)is true. Gem oe loff rs Print yped ryame. y Signa Montlt Day Year Vn(�/1i1V�.. 1. 7 h 16.International Sldpmants ❑Impo m U.S. ❑Export from U.S. Pad of entrylexit: _ ? Transporter signature(far exports oniy): Date loaning U.S.: W 17.Transporter Acknoviledg wd of Receipt of Materials CTransporter 1 Printedrryped Name Signature Month Day Year a � � S s' zn Transpoder cin y Name Signature Montle Day Year !8.Discrepancy 18a.Discrepan y Indication Space ❑ouantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: I8b.ARemate Facility(or Generator) U.S.EPA ID Number J U F-d'y's on.-. w 1ec.&grebre of Abmate Facility for Generator) lAdnU Day Year z N19.Haxadous Waste Report Management Medved Codes t.e„cedes for haws waste trealmenL disposal,and mcyding systems) � 1 H141 2 Hi41 3. Hi41 4. H14i 20.Cesgnated Fadlty Owner or OperaW U01ceition of receipt of hazardous materials covered by V manifest eiroeponoteld in Item Nnledrryped Name Signalu Month D y_ Y r EPA Form 8700-22(Rev.12-17)Previous editions are obsolete. D GNAT FACII ITY th El EST SYSTEM Clean Harbors has the appropriate permits for and wiaccept the waste the generator Is snip g. 71 20022 PP W /