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1'7b b 3)536 j/ Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS t,Generator-11)Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST310-344-0025 009811811 FILES7A.G�meneratals Name and Mailing Add�ress Generator's Site Address(it different than mailing address) 10i68nWe9i Liiatl taRoad Ameron International Tracy, CA 95376 10100 West Linne Road Generator's Phone: homasinsil Tracy, CA 95376 6.Transporter 1 Company Name U.S.EPA ID Number Dillard Environmental �� 7.Transpo r2C mpany Nartmm{EEE�� C P/0r UrG U$, EPA ID Number S.Designated Facility Name and Site Address U.S.EPA mbe Clean Harbors 81 Dorado, LLC 3109 American circle A R D 0 6 9 7 4 8 1 9 2 acTty's)f�io ado 7 - 6 71,)7 0 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, HM and Packing Group(if any)) 10.Containers 11.Total 12.Unit 1. No. Type Quantity Wt,Nol. 13.Waste Codes p B RQ, UW1993, Waste Flammable liquids, n.o.s. (Light OF G 331 D001 1- aromatic solvent napphtha, Isocyenic acid, I ' polymethylene polyphegylene ester), 3, pG II, ' Z z 2. UH1444, Waste Ammonitmm persullate, 5.1, PG III, OF (HFPA CLASS 1) ' P 141 DO01 3, S 4 I — i s I 14.Special Handling Instructions and Additional Information 1. 0053620-se LcORn (1611-23275) ERGO 129 Commodity Pack A 10%27/16 (Clean Harbors El DoradoAll 2. CC53620—Bp LCCRo BFPA CLASS 1 (1611-23273) ERG# 140 Commodity Pack B 10/27/16 (Clean Harbors .Bal 15. GENERATOR'SIOFFEROR'SCERTIFICATION: (hereby deGare that the contents of this consignment are fully and acoura ely described above by t e proper shrppmg name,and are ass ed,pec N marked and labeled/placaMed,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 EPAAcknowledgment 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. Gene,[atols/ rots Pnnted yped Name OV,(/ bet'i F OF Yp}x/ gna ure on ay ear I i6.Intemafimna ShipmRAO Z Ll Import to U.S.Trans orter si nature ❑Export from U.S. Port ofentry/exit: for exports only). Date leavingUS.: w 17.T'anspoderAcknowled6entofipt ofMatenals 7 T iter 1 Print a a0 ign to onay /ear sit Q Transponer21'm- lr ed Name 112-4 l kill— Mo/n ay ar — (t1 � / t18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: iBb.Alternate Facility(or Generator) � U.S.EPA ID Number U Q �- FaGli 's Phone: w 18c.Signature of Alternate Facility(or Generator) Q Month Day Year Z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 2. 3. 4. 20.Designated Facility Owner or tar:Certification of receipt of h Mous materials covered by the manifest except as noted in Item iSa PrintedFryped Name Sgnature Mo Day V EPA Form 8700-22(Rev.3-05) Previous editions are obsoete. DE GNATED ILITYTODESTINATIONSTATE(IFREQUIRED)