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743237314 5C PPW 0/2. _J10 <br /> Please print or type.(Form designed for use on elite(12-p(tch)typewriter.) Form Approved,OMB No.2050.0039 <br /> 1 e er lg ID Nu be 2.Page 1 of 3.Emergercy Res ons,Phone 4.Manifest Tracking Number <br /> UNIFORM HATARDOUS � 0'6'6 6 0 0 2 9 3 � (1300,48�-371£� <br /> WASTE MANIFEST 0 0 0 0 68 0 7 4 M W 1 <br /> 5. - ra r' lam d li Ad res, Generator's SileAddress(ifdifferentthan mailing address) <br /> drin�°'�i�or l�ka 1��r0 ucts <br /> 26700 South Banta Road SAME <br /> Tracy.CA 95376 <br /> Generatar'sPhone: (2091635-5424 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Clean Harbors Environmental Sertrices Inc MAO 0 3 9 3 2 2 2 5 0 <br /> 7,Transporter 2 Company Name U S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Clean Harbors EI Dorado LLC ARD 0 6 9 7 4 81 9 2 <br /> 309 American Circle <br /> El Dorado.AR 71730 <br /> Facilitys Phone: (8701663-7173 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. UN3262.CORROSIVESOLID.BASIC.INORGANIC.KOS_ L81 <br /> 0Q X (SODIUM HYDROXIDE),8,PG 111 <br /> Z 2. <br /> W <br /> i <br /> 3. <br /> I <br /> 1 <br /> 4. ( <br /> 14.Special Handling Instructions and Adgiitonal Informafion <br /> I-CH47�4661 i}G'SS.UF mm4im <br /> (0 7]l 323-7stq <br /> 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, <br /> 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 <br /> Exporter,I certily that the contents of this consignment conform to the terms of the attached EPAAck nowledgment of Consent. <br /> I certify that the waste minimization statement idenfified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's! fferors Printedlfyped Name SignaluJ� Month Day Year <br /> ,.f2 <br /> 16.International Shipments <br /> K- ❑Import to U.S. ❑Export from U.S. Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknowledgmerit of Rece0t of Materials <br /> K Transporter 1 PrintedlTy ed e/ Signatur Month Day Year <br /> Z <br /> 164 4 [.s - � r /z Vii ) <br /> za Transporter 2 PrintediTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> I <br /> 18a.Discrepancy Indication Space ❑ ❑ ❑ <br /> ❑ Quantity Type Residue Partial Rejection Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number I <br /> J <br /> U <br /> ui. Facility's Phone; <br /> 18c.Signature gfAllernate Facility(or Generator) Month Day Year <br /> LU a <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> M040 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Printedlryped Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY'FQ STA7'F (IF t?fFC7tlIIPt z�) <br />