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Phase pdM pe.(Fmm Oeaignetl for use oD all(1&ptop typawriNc) /90%p0703 SCPPW 10 10 2017 Farm Appoved.ONE No.20500039 <br /> UNIFORM HAZARDOUS 1.Gmeralre lD NUmbe 2.Pine td 3.Emagenry Respemse PrimeA lumberTreaki,Nam. <br /> 94-31 <br /> WASTE MANIFEST511 FLE <br /> S Gmerela's Name aM Mailiy Atltlress Ge eralp SM resa(If I exn rger main,yea re e) <br /> DTE Stockton LLC <br /> 2526 W.Washinoon Street �F9a W W..H,.ar..QNeel <br /> cr.r.M.r..r ra oG�nz <br /> Stodaon.CA 95203 <br /> WM m \ U.S.EPAID NumCer <br /> A 17 <br /> f l c -�-J� C L1.✓OOJISg34} <br /> ].Tmrapmer panyN U.S.EPA ID rambler <br /> 8,DesereNd Reality Name and Site Address US.EPA IDNUmber <br /> CW-Harbors ButtomEiOow LLC <br /> 2500 West Lokern Road CAD 9 8 0 6 7 5 2 7 6 <br /> Ij F 'flow.CA 93206 <br /> (436M;62 6209 <br /> 9e. gb.U.S.DDTDesrnpton(WLU VPrt Sbipglg Name,HeanNClass.IDNu .. to.0 ra tt.TdalCeenly, 12,UM <br /> Fl-� HM aM PaGirg 6muP lRdrryl) Na. T WAM 13.Wmle Catln <br /> c lBN1759,OORROSIYESOLIDS,N.OS.,(ARSENIC.CHROh1111ft l A� <br /> rn x 6,PG 111,(BOTTONIASH) H n <br /> w T <br /> w 2. <br /> 3. <br /> a <br /> 1d.Sp�tialHmdtirg lnsWrAoreantl AtldiliwW Inbmatim <br /> 1-CH1346380 ERG6159 <br /> 15. GENEMTORVICFFEROR5CERTIFICAPON: hereby tledare Nal Ne mnlenk dNis wnsgnmenlam folly aM aauraerydeScribed above by Ne DrWar Nipp'vg ruine,antlare agspfied,packaged, <br /> marketlaM la[elesNa"Ne1,and am,in all ea,ec6 in pimpereoryiliat Iw Irenspmlaaprdq loappllable inlamalional and national govemmenNl repulaliwis.11egalahignenl and em mi,mune,Engage, mHy Nalthe mnimiso(tivs ensignmens-rarm to1be termsoflM alUdretl EPAAcknowledgmml oICmsml. <br /> I Cal0y mat Ne waste rrnim'vatlgn segment gentsel in 40 CFR 26327(e)(dl am a large glia bt,generabrl or(b)(dl am a amall quantity generatorl is <br /> l d a re <br /> Y mr <br /> 16hrMmreeNNISNP me ❑Impmlb U.3. <br /> Te Mr " area bre DN ❑Eaorlmm LLS. P ale t <br /> w 17.Tmminler Der lreri U.S.: <br /> AckrpMetlgnrenldRmytd MamrMM <br /> TmnapMer1 Pn ypW Name gndu <br /> Shw Kam o o Year <br /> = Tmnapodn]Pdnledllypetl <br /> Igna e Y ear <br /> 1 18,Dkaepmq <br /> I Iae DiavWenry Maiden Spat, ❑ careen, ❑Type ❑ResiMe El Feel Rel, . El FUN Perigee <br /> Ieb.hNeare Finlay(m Geeslin) Manifest Relaer�NumEe: <br /> � LLs.MID Mrmbe <br /> U <br /> LL Far'Sil Plwne', <br /> 18p.SgnaMmdMernaM Fekiry(a Gererdlp) <br /> Q Monty Day Year <br /> _ <br /> Wtq,Haaeapua Waste Ream Meegemaal Metlgtl Cotles(i.e..mdcubbererrpUswaem bmNnnl.9speealayingchnpayslemsl <br /> � Hi32 2 a. <br /> ZIP Deny red FasiiN Oanera0perabC CeAkaponolremgdlldadlrbug makn'els mveredpy ygagrvMNaxraptasrobtlnllem lBe <br /> 1 FtlnteMypetl rydme �-. <br /> "18 /` 7 M�A DEay� Year <br /> fL <br /> EPA Form e]00.22(Rev.I9-0NSIAJPrevitolusAeOtlilians are orsokte. DESIGNATED FACILITY TO DESTINATION STATE IIF QUIRED) <br /> Clean Harbors has the appropriate permits for and will aasepl the waste the generals is shipping, <br />