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Please print or type.(Form designed for use on elite(12-pitcpewriter.) • Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number "' ' Y.- 2.sage 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL0003372T6 1 1-800-468 .1760 00 )51343 SKS 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) PACIFIC ETHANOL 3028 NAVY DR STOCKTON CA 95206 Generators Phone: 209-235-0373 6.Trans rter1 Com an Name U.S.EPA ID Number T})R000050930 SAFETY-KrFFN SYSTEMS, INC. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address CIS ECOL00Y NEVADA 05OSO5 U.S.EPA ID Number 11 MILES S OF BEATTY HWY BEATTY MV 89003 Facility's Phone: 775-553-2203 NVT33001.0000 ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containam 11.Total 12.Unit 13.Waste Codas HM and Packing Group(if any)) No. Type Quantity Wt./Vol. NON-RCRA HAZARDOUS WASTE, SOLID DM P 141 o (SULFURIC ACID NEUTRAL12ED WITH SODIUM „fir a CARBONATE) �u� 2 Z 2NON-RCRA HAZARDOUS WASTE, SOLID DM P 352 (UREA) ^ :.)0 0 3. 4. 14.Special Handling instructions and Additional Information SK TRCK#110050752 0003281438 SK AUTHORIZED TO RETAIN LICENSED SUBSE, UENT CARRIERS AS NECESSARY , � 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above b ih p s ing name,and are classified,packaged, marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmen gulati ns.It export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the tens of the attached EPAAcknowledgment of Consent. I cer8ty 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. - GeneratoeslOgerors Pri tedlfypehNIpme Signature - -ro Month Day Year 16.International Shipments ' F El Import to U.S. ElExportfrom U.S. Pon of entrylexit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Prin dRyped}}Name Signature Lawl Month Day�r Year d �'(.. f ,�:�q.r�1 pL+� ✓�" .,i C yr7F r„N'","'+-+"".' ... J�d ..�Y �. y Q Transporter 2 Printed/typed Name Signature -^ Month Day Year r 18.Discrepancy .. 18s.Discrepancy Indication Space ❑ Quantity El Type El Residue ❑Partial ReJeciron El 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 a z y19.Hazardous Waste Report Management Method Codes(la.,codes for hazardous waste treatment,disposal,and recycling systems) 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 Pnntedrryped Name Signature Month Day Year E AF�(�rb87Q�0,6(Rjv)3-W)2� v,�ougs�diTyareobsolete. 4) GENERATOR'S INITIAL COPY 1)21417015!40301387 2)2417017/40301385