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SSL SK SHIP# 227790489 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me e Re e P �p 4.Manifest Tracking Number WASTE MANIFEST CALON 152025 I �� 1�� 006959864 S KS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) JC Tracking Inc 1415 W. Anderson St. STOCKTON CA 95206-0000 Generator's Phone: 209-466-3282 6.Tr p L�pmp�py� SYSTEMS INC U.S.EPA ID Number T X R000081M 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC, MAD0393222513 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number 1.021 BERRYESSA ROAD SAN JOSE , CA "35133 CAD059494310 408--441--0962 Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes v. NONE NON RCRA HAZARDOUS WASTE SOLID£, C; `� . o (EMPtY DRUM+�S), N/A F L2 hdt dE, NON RCRA HAZARDOUS WASTE SOLIDS, p � P -52 (OIL, DIRT AND SAND), N *- J r NBME, NON RCRA HAZARDOUS WASTE SOLIDS, ,. D P 352 (OIL., DIRT AND SAND), N 4. 14.Special Handling Instructions and Additional Information T3D:SJ 79370863 JC 1 0636 CRG 24H EMERCF-NCY#800468-1760-CH/S4(/TFI-•Contrract retained by generator confers agency author i y 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 certify that the contents of this 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)(if I am a large quantity generator)or(b)(if I am a small quantiy generator)is true. GeneralsOfferors Printedffyp d Name f Signature e ,! ,� Month Day Year 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Po�'of-enf y/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials 11.2 Transported Printed/TypeclAame Signature %"I Month Day Year r , ZTransporter 2 Pr!Typed Nam t" Signature Month Day Year t- 18.Discrepancy 0 18a.Discrepancy Indication Space ❑Type `'"r ❑ Quantity yp El El Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ 0 if Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) LU G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22((Rev.12-17 Previous editions are obsolete. GENERATOR'S INITIAL COPY 1)8553940/1793512 2)85.5'9293/1797'9'31 3)8559283/1797291