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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000152025 2 800-483-3718 006959863SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) JC Trucking Inc 1415 W.Anderson St. Stockton CA,95206 Generator's Phone: 209-466-3282 6.Transporter 1 Company Name U.S.EPA ID Number Safety-Kleen Systems,Inc. TXR000081205 7.Transporter 2 Company Name U.S.EPA ID Number Clean Harbors Environmental Services,Inc. MAD039322250 8.Designated Facility Name and Site Address U.S.EPA ID Number Clean Harbors San Jose LLC CAD059494310 1021 Berryessa Road San Jose CA,95133 Facility's Phone: 408441-0962 ga 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 1.NONE,NON-RCRA HAZARDOUS WASTE,SOLIDS,N/A,NONE,(EMPTY DRUMS) O 10 DM 10 P ;i 512 W Z 2. W U' 3. 4. 14.Special Handling Instructions and Additional Information Line 1:Profile:1793512; 15. GENERATOR'S/OFFEROR'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 quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year SIGNATURE ON FILE SIGNATURE ON FILE 02 27 2019 16.International Shipments1:1 FImport to U.S ❑Export from U.S. Port ofentry/exit: z Transporter signature(for exports only): Date leaving U.S.: Ll 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a Ray Gomez I Ray Gomez I 02 I 27 12019 N Z Transporter 2 Printed/Typed Name Signature Month Day Year W Bruce Bartlett Bruce Bartlett 03 06 2019 F 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 U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. H141 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 David Baker David Baker 03 15 2019 EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM