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h 50 ; ISr� v �9�J Ple%Or nt or type.(Form designed for use on elite(12-pitch)lypewdler) Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Genealor lD Number 2.Pagelof 3.Emergency Response Phone 4.MankfastTracking Number WASTE MANIFEST cZ a— 012 7 9 619 0 JJ K 5.Generators Name and Mailing Address Generators$As Address(if different than mailing address) PILKINGTON NORTH AMERICA INC PINT 10 500 E LOUISE.AVENUE �sAt«1E LATHROP,CA 953 GeneaWrs Phone: a 6.Transporter T Company Name U.S.FPA 10 Number WORLD ENVIRONMENTAL&ENERGY INC. 7.Tmnspoder2 Company Name U.S.EPA ID Number - 8.Designated Facility Name and Site Address U.S.EPA ID Number CLEAN HARBORS BUFTONWILLOW LLC CA173975275 2500 W.LOCKERN ROAD BUTTONWILLOW,CA 93206 USA Facility's Rare:..651-762. ge, 9b.U.S.DOT Description Including Paper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(@any)) No, Type Quantity Wi.Nat o % 1' N,A8077, HAZARDOUS WASTE, SOLID,N.O.S., (LEP.0),9,PGIII DM P DPJB 181 v W Z. 3. ;, 2017 I 4. (AL - r 14.Special HaMrrng Instructions and Additional informalium PROFILE#.CHtC08323 PO#.536 (Fq ERGM71 RCRA PAINT CHIPS WITH INCIDENTAL DEBRIS 15. GENERATOR'SIOFFEROR'SCERTIFICATION;I hembydsdare that Ne contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and latieledlplararded,and arein all respects in propercondition for Iareport according to applicable Intemsionaland national govemmenlal regulati if export shipment end I am the Primary Exporter,I mrtity that the contents of this consignment conform to the terms of the attached EPAAcknMedgment of Consent I ceNry Nal the waste mirymivallon statement identified In 40 CFR 262.27(a)(f I am a large quantity generator)or(b)If I am a small quantity generator)is We. GenealoeslOfferbrs Pdnt2ed Name . O/V /-0k Signature MZ Day Year J 16.Intemallonal Shipments ❑ - i— Import to U.S. ❑Export fiom 0.S. Pod ofenlrylexil: z Transporter signature(for exports only): Date leaving U.S.: w 17.TansporterAduiowledgment of Receipt of Materials K Tra 1 Pricutedirrypedj4ame Signature Month Day Year a Transporter 2 Pri edRyped Name (\�\ Signature Month'(0 . Day Year ' _ �rw� ~ -- Aw {, 18.Discrepancy 18a.Discrepancy Indication Spam ElQuantity El Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. l8b.Altemate Facility(or Generator) U.S.EPA ID Number j U rai Fadlity'e Phone: w 16c.SlgnabimofAltemate Facility(orGeneator) Month Day Year Q Z y19.HaM*M Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G t // 2 3. 4. 20.Designated Facility r Operator:Certification of moot offrazardous materials covered by the manifest except as noted in Item 18a — ll PdnledVTyped Name Ignalure Mo Day, Year EPA Form 8700-22(Rev.3-05) Previousedilronsareohsolele. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)