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Pia: � enerator acflnorrledaes that no material change has occurred efther In the characterWIL,*or n the process aenernna trfamm rial. oh16 No.2050 coos UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Mantfest Tracking Number WASMMANIFEST CAR000212605 1 [ 483-� 1 019663422 FLE 5- eratoe Name and Mailing Address Generators Site Address(if different than mailing addMa Fd. a AId 6291 1970 West Grantline Road SAME Tracy,CA 95376 Generators Phone: f 2(8) 830-7388 6.Transporter 1 Company Name U.S.EPA ID Number Clean Harbors Environmental Serviws,Ino. M A D 0 3 9322250 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 lose LLC GAD 0 5 9 4 9 4 3 1 0 1021 Berryessa Road San lase,CA 95133 F Phone: ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,iD Number, to.Contalners 11-Total 12-Unit 13 Waste Codes HM and Packirg Group Ii,f any)) No. Type Quantity vftrvd. 1-UNi950.WASTE AEROSOLS,FLAMMABLE,(EACH NOT D001 ;D035 331..-- vF x EXCEEDING i L CAPAGITY� 2.1 001 C F 00006 P .-.----r.-_.............. a� U 2. UN2810,WASTE TOXIC LIQUIDS,ORGANIC,N.O,S,(2,4-D. U035 ;U044 ;11058 PHENOL],G.i, PG 11 0 0 1 C F 00037 P __-------, ._..---------._-.. _-.. X U072 ;U129 331 3'NONE RA HAZARDOUS WASTE, LIQUIDS. (SOAPS,LOTIONS] 331 ;343 0 0 1 C F 00447 P -----------f 4. i t 5 Handling Insiructons and AddibmaUr fomt2tion 1 —A, 0 tir:{ii11b IYLU 2-RR"—ToxLiq EMG;6153 IX20 3.RI—CA-1 cnReg—I 1YFBIN Contract retained Giri}erlgatar c4Trfers agency 15. GENERATOWSIOFFEROR'S CERTIFICATION: i hereby declare that ire contems of this oonsignment are fully and aocuratefy described above by the proper shipprg name.and are dassffi ,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.if export shipmem and l am the Primary Exporter,I certify that the contents of this consignment conform to he terms of the attached EPAAdrrhowledgmerd 0 Consent I certiiq that the waste minimization staternent identified in 40 CFR 262 27(a)(d I am a large Warr*generator)or(b)(di am a small quantity g&x4B or}is true. GeneratoesrOfferors Printedrryped Name SgnaWre Month Day Year ROBERT HOLCOM B ON BEHALF OF a 16.Inlemational Shipments 11— ❑Import to U-S. Export from U-S. Port of entrylut: a Transporter signature(for exports only): Date leaving U.S-: me 17.Tmmporter Acknowledgment of Receipt of Materials p Transporter 1 Printed(ryped Name Signature Month Day Year fi ~ Transporter 2 Prinletl Vip mapame Signature Month Day Year. F IS-Discrepancy 18a.Discrepancy Indication space ❑ 0.fity ❑Type ❑Residue ❑Patiai Rejection ❑Full Rejection Manifest Reference Number: 1 fib.Altemate Fac*for C,enerawo U.S-EPA ID Number J_ L] L FadWs Phone: to 18c.Signature of Altemats Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i-e-,codes for hazardM waste treatment.disposal.and recydirg systems) LU 1. 2. 3. 4- H141 Hi4i Hl41 20-Designated FaciliOwr or Operator• cation of repot of hazardous materials covered by the manrfest except as noted in hem 18a PrfntsdlTyped 7fwA4 signature Y �z,, EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. 4E51GNAT AGILITY TO EPA's e-MANIFEST SYSTEM Liearl Hartlors has the appropriate permta for and wit accept the*awe the generator is snipping- 6#R 250364S237 PPW