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7� Please print or type.(Form designed for use on etile(12-pitch)typewrite'.)P!45005`;2835 - - Fonn Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2. etof 3.Emegerwy Response Phone 4.Men sl IT kin Number -WASTE MANIFEST .CAT0.4DG 17$J'�4, _ r (000)493-3711 - 080541.26 FLE' 5.Generators Name and Mailing Address .Generator's Site Address(f different gran mauling address) NuSTar Termirsals 0�;Ier33ioa1s Paw marsW5 LP 2941 www Brim 5,69E Stockton,CA 55206" Generators Prone: i20919435662 6. ranspMer 1 Company Name U.S.EPA ID Number dean Harbers Ertvww rnemI Serwc*s Inc rO A D D 3 9 3`22 5 0 7.Transporter 2Company NameD Number SL+ - - - AZIRCW 5793• /Oa 8.Designated Fa ifdy Name and Site Address U.S.EPA ID Number- • - , Clean Harbors Aragonite LLC U 7,D S 91 5 5 21 7 7, 11600 NorthAotaes R" Grarstsvltle-ut9l029 Fang �s Phone: t4i5A u87d-[CS.Q1�➢ - - _ gra, 9b.U.S.OOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1D.Containers 11,Total 12.Unit 13.Waste Codes HM and Fading Group(if any)) - No. Type Quantity wtivol. 1. UPI3175,WAM- 63LIDSCONTAININGRAWJt'91' IC6:UQUID. 352. D001 D005 o -t N.OS.,(DEV FUELl.4.1.FG it 70 : w 2 opa30a7,��ai0 ac.: t'aYA1L?r bG 961ogtGs7 �CES. 352 ' SOLID.N,OS_(BENZENE).9.PG III eo !M q0 3. // y' 4. IT 14.Special Handling Instructions and N imagon tional Info 1_CH30&19i 1 #�.r31. Eid'34i`13a55�-1QSb2oa^O�. 5'152.CH3.10907' --SY f 5- ERGS ?1 �'��1`3'bs2�^6D -Di)/5M-NS'6 V5- 15.. ..GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the pmpershipping name,and are dassfied,packaged, marked and Iabeled/Dlacarded,and are in a8 respect in proper condition for transport according to applicable international and national governmental r ornorn.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment contemn to the tens of the anached EPAAcknowledgmenl of Consent.' - I certify that gra waste minimization statement identified mill)CFR 262.27(a)(if Iran a large quantity genemtor a guantiry lot)is hue. eneato Pd eEliyped Na ,, iIi Month wy Tear, J 16.International Shipments r ❑Import to U.S. ❑Export hem U.S. PcdfelilryiesdE ' Tans iter signature for exports only): - Date leaving U.S.: W 17.TansporterAckwMedgment of Receipt of Materials Transport Pdnted/Ryped Name gnature an ay ear IX ILI nllo� Month Day Year Q T 2Pnn GYped N['V/.Jun o� 23 /l) 1/1 i18.Discrepancy 18a.Discrepancy Indication Spew ❑ Quantity [--]Type ❑Residue ❑Partial Rejeclion ❑Full Rejection Manifest Reference Number. I So.Alternate Facility(or Generator) U.S.EPA ID Number t J LL. Fade sPhone:.- W I&.SigwtureolAltemate Fadliry(or Generator) - - - - - - - - - -Month Day- --Year - Q Z y19.Hazardous Wdste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 M040 2 H040 3' a. 20.Designated Facility Purer of Gears#Certification of receipt of hazalloa matereLs covered by the manifest exceptas notod 111tern 15a 1 Pdntedtfyped Name 1 SgWa � naMonth �1 y \� r EPA Form 8 00 22 ReY,3-051 P vlous digons are obsolete._ 77 Q IGNAjED FAIL TO GENERATOR STATE(IF REQUIRED) Ciea:T�arro7s hyDDTGDria?e Dsrm�s BOT rs!i hili aer.Prt gha vastQ tQeF '+a or ca s.rEDP . 12020.1438 "