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SSn . _ - -- —- -- .-- ---- Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3. me R s o se Pt�, 4.Manifest Tracking Number WASTE MANIFEST CAL000433477 �—t I SO 011837170 FLE 5.Generators Name and Mailing-Address — 9 Generators Site Address(if different than mailing address) S eedco Truck Lute #338 S 99 At Jackstone Exit - RIPON CA 95366-0000 Generators Phone: 209-399-7961 6.Tr n er 1 Com an Nam U.S.EPA ID Number _i pr TY-TNffln SYSTEMS INC TX'R00008 i 205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. I MAD039322250 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number 1021 BERRYESSA ROAD SAN JOSE , CA 95133 408-441--0952 CADO 59494310 Facility's Phone: 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)) 13.Waste Codes No. Type Quantity Wt.Nol. 1. NON-RCRA HAZARDOUS WASTE, SOLID DM P 223 w Z 2. w r, 3. 4. 14.Special Handling Instructions and Additional Information TSD:S T 77383927 SP22107 I� CSG 24H EMERGENCY#800-468-1750-CH/SK/TFI-Contract retained by generator confers aggenvy authori on initial transporter to add or substitute additional transporters on enerator's behalf. 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 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,,, generator)is true. Generatoes/Offeroes PrinledfTyped Name Signature Month Day Y,ar 16.hnerrtaUutlal 5hlprnents I I — z LJ Import to U.S. Export S. Port of entrylexit Transporter signature for exports only): Date leaving U.S.: Of w 17.Transporter Acknowledgment of Receipt of Materials �— Transporter 1 PrinterllT d Name SignAre I Month ay ar Transporter Print ed/T me Signature Month Day Year 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 Q Facility's Phone: Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year r— Q z CD Cn 19.Hazardous Waste Report Management Method Codes(i.e.,odes for hazardous waste treatment,disposal,and recycling systems) 0 1 /W/ 1 2. 3. 4. — O-Designaf ci%t ner -OperaTor:yertifigAtion o r ipt ofhazar ous atenals i by the manifest except as noted in Item 18a ----- Print edff Signa ure M Da Y EPA Form 8700-22(Rev.3-051 Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)