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Please prim or type. GJ 1906092696-001 SG PPW 12/9/2008 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number age f 3.Emergency Response one 4.Manifest Tracking Number WASTE MANIFEST C A E 0 0 0 2 6 3 7 9 4 2 (800)483-3718 014 218 718 FLE Generator's Site Address(I different than mailing address) 200,,��rF.N Wagner Ave SAME t3 i. Jyun,i-A 95i1J !S2 tit J11 3^a Generator's Phone: t 'r'* oav 5.Transporter 1 Company Name U.S.EPA ID Number Glean Harbors Environmental Services.Inc. MAD 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 lean Harbors San Jose LLC G O O S 4 4 3 10 1021 Berryessa Road San Jose,CA 95133 Facility's Phone: AM 44 4_04ACn12 9a. go.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('f any)) No. Type Quantity WtJVol. r 1. UN1950,WASTE AEROSOLS.FLAMMABLE,(EACH NOT X EXCEEDING i 1 CAPA0M.2.1 0 0 1 D F 00004 P D001 331 z UR 993.WASTEFI 4MMMLELtQUIDS,K.OS..(PA(UT D00i 331 RELATED MATERIAL.)SOPROPYL ALCHONOL).3.PG It 0 01 CF 0 010 i P s. UNiS24.WASTE SODIUM HYDROXIDE SOLUTION,$.PG 11 001 G F 0 G 0 0 T p D002 141 14, 4 13254.WASTE CORROSIVE LtQUI[B.A0101C,t1140I GAIIIC, D002 141 X N.O.S..(MURIATIC ACID.SULFURIC ACID).8,PG 11 0 01 C F 00062 P 141Sp a&dling Instructions and A+ p(o�p�ton 2-LCCRSI�t ERG#128 1X55 3-LC ERG#154 1yX5�n (�� af3kn r,k ;tiiidl tr,rs�GTSE ' 5vb51fflTli�add�iunat 1rdnr-j;Mt'T5 un geneF3 ovs Ueti3N LUT ll Gst?5 f1t 1T3nsGfrTtal cm g1EVCieninerGaGtn°it TT1 nG�e L�r10S 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 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 certity that the contents of fhts 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)('f I am a large quantity generator)or(b)(di am a small quantity generator)is true. Gen atorslOfferors PrintedlTyped Name Signature Month Day Year 01 103 120 TISInt mational Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit ? Transporter signature(for exports only): Date leaving U.S.: of W 17,TranspWHAcknowledgment of Receipt of Materials 1�— Transporter 1 PrintedlTyped Name Signature Month Day Year d RIGH DECKER Dth 03 ZO Z Transporter 2 Pdntedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J Q LL Facility's Phone: LL, 18c.Signature ofAltemate Facility(or Generator) Month Day Year a Z rn19.Hazardous Waste Report Management Method Codes(0.,codes for hazardous waste treaInwt,disposal,and recycling systems) LU 1 H141 z. H14i a H14i 4 H14i 20.Designated Facility qwner or Operator.Certification of receipt of azardous materials covered by the manifest excEVs noted in Ite PrintedlTyped Name Signa Month Day Yea Ai 1�.�& 69/1W. ".. 0 EPA Form 8700-22(Rev.12-17) Previous edition are obso DES TEjD F ITY T EPA's e-MANIFEST SYSTEM Clean tiarbars has the appropriate=permits for and will accept the waste the jeneralpris s fppt