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slat <br /> SSL . 6K SHIP# 229755903 � I� l <br /> Pease print or type. C om1 A provJ OMB No. 2050.0039 <br /> — UNIFORM HAZARDOUS I . Generator ID Number 2. Page 1 of 31 m R s 107313927 <br /> anifest Tracking Num er <br /> CAL000413716 6 5 KS <br /> WASTE MANIFEST <br /> 5T, Generators Name and Mating Address •tom Generator's Site Address (if different than mailing address) <br /> Caliber CollieaoT: 'b...Stockton # 1060 <br /> 32j@ M Wilson Way Location ID# — 1060 <br /> STOCKTON <br /> Generator's Phone: 209--469-7091 <br /> s. IffliStftll.Corrlgen SYSTEMS INC U.S. EPA 10 Number TXROOOO81205 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8, Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE, LLC U.S. EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> ARAGONITE , UT 84029 <br /> 435-884-811> UTD981552177 <br /> 9e, gb. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 1 t. Total 12. Unit 13 Waste Codes <br /> HM and Pecking Group (if any)) No. Type Quantity WtNoi. <br /> X 1 UN3175 WASTE SOLIDS CONTAINING DM P FOO F005 D@01. <br /> o FLAMMRILE LIQUID NAOSS ( TOLUENE , <br /> METHYL ETHYL KETbNE ) , 4 . 1 , PG II D@@ D8@6 352 <br /> w 2. pe <br /> or <br /> 4r gal 11132 ) rA 2 <br /> 47 <br /> 3, <br /> 4. <br /> 14, Special Handling Instructions and Additional In tion TSD : A13 81264716 CA65817 CSG : <br /> i ) ER(3# 133 • I c 10 � �rzr ) Pwo <br /> 24H 6MERGFNCY#8@@-468- 1760- t:H /SK/TFI —Contract retained by g erator confers a envy authori. l y <br /> on initial transporter to add or substitute additional trans otters on generator ' s beh f . <br /> 15. GENERATOR'SIOFFE FVS COIihr1CATIGN: I hereby declare that the contents of this ooiislgriinerit are fully and accurately described above by the proper shipping name, and erd c "I'le�, p6 dtaged, <br /> marked and labeled/placarded, and are it allrespects In proper contrition for I"port according to applicable international and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I oertify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(x) (d 1 am a large quantity generator) or (b) Qf I am a small quantity erator) is true <br /> GenaratorslOfferoes Pri yped Name sign at nth Day Ye <br /> x Yom_ � � lX ' <br /> a 16. Interna nal Shipments <br /> f ❑ Import to U.S. ❑ Export from U.S. Port of entrylexit• <br /> 2 Transporter signature (for exports only): Data leaving U.S.: <br /> 1% 17. Transporter AdTawledgment of Receipt of Materials <br /> Trawrter 1 PdnterYTOetf Name Signatu Month Day Year <br /> r Hyped Name Sig Monjh Day Y r <br /> 7,6 <br /> 18. Discrepancy <br /> 18a, Discrepancy Indication Space El Quantity ❑ Type ❑ Residue ❑ Partial Rejection Q Full Rejection <br /> Manifest Reference Number. <br /> 18b. Atemate Facility (or Generator) U.S. EPA ib Number <br /> r <br /> ij <br /> ua FacilitysPhone: <br /> rL 18e. Signature of Alternate Facility (or Generator) Month Day Yea' <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes Q.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> is 1 A 12P 3. 4. <br /> 20. Designated Facill n or Operator: Certification of receipt o azardous materials covered by the manifest except as noted in Item 18a <br />( Printedflyped Namel I Month Day Year <br /> AA I dq <br /> EP L M4 +Mv �11ya 1` io e " DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />