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9CPPW 0/iiPlease print ortype.(Fmm designed kr use on elNe(12 NrA) .) Z001789 Form Approvetl.OM3 No.20560039 <br /> UNIFORM HAZARDOUS 1 Giardini ID Nwroer 2.Fagelol 3.Emalger,Response Phone A MenIIeM Treckin9 Number <br /> WASTE MANIFEST59102CAL000359102 1 {800)4833718 011584016FLE <br /> 5.b"WIdd WLLV"Address Genxetofs Sih Atldress a dement Nan mod,address) <br /> 2526 W.Washington Street752c W!Yashire. cas_aeL <br /> Stockton.CA 95203 Stockuti 95203 <br /> �narotaa Pnpm:(2091320-3714 ATTN:lesse Lewis <br /> 6.Treardinkin I Cmi Name US.EPA IO Number <br /> ].Tromppner 2 Canpany Name U.S.EPA ID Number <br /> 8.DesignateFadlity Name antl Sita Address U.S.EPAID Number <br /> Clean Harbors BuOamriNow LLC CAD 9 8 0 6 7 5 2 7 6 <br /> 2500 West Ltakern Road <br /> Buttornrillow.CA 93206 <br /> FmAitye Parra: f6611762-6200 <br /> 8e. 90,US.DOT Daeor4fio^IinmdvM PmpNShippvlg Nemo,HemtC Cem,DNMMx, 1O.COMsiears Ir Tout 12,Una 13.1haete Codm <br /> Her and Parkims GraV(RarM1')) Np, Type Oeantlry Vii <br /> Cid 1NON42CRAHMAR000SWAM.SOLIMOLYASH) 571 <br /> / D>r33,4Hp P <br /> w <br /> 3. <br /> 4. <br /> i/.Speriel Hantllim lnshYLbre148MPb]ilvMlal ln(dmdOpn <br /> 1.CH6a17536 <br /> 15. <br /> marked <br /> and W'SgiFEROR'S and <br /> are in allm IAevebydedare Nal Nemnhnhpl tNsmnmgnmeniremegand aarad and <br /> nimcdbedabrnmer It proper snippnmarr amandaedaseifie,peemal <br /> marine id ery Mat Me cone,and ares all respects in piper mndApm brtremp0d accprtling Minderrhadg inNmaCom aM national gpvammmhl rtgulafipns.Nexppn shipmmtalb am tM PMrary <br /> Erypr10',I cedily Nat the mnknh pllM1is Wnaignm¢ntmnMm b Nnlwms OfllCdtldehed EPAAUmmNedgm¢nlpl Consent. <br /> eradery Mal Neweab min'anvafim sbhmMl Mmtlfie in 90CFR26227(a)(tl am a eryequendry9emrobN pr(bl(M l am a small Nwnary gmemtor)is We. <br /> Gra <br /> Y ear <br /> a 6 9 20 <br /> J ffi.Inhmaama Shipm N ❑ImpM Ip US. ❑E>pddfipm V.S. Pat enoyl 5'. <br /> Tradrapdrim,m rendre primpime ordi Date lens US.: <br /> IC 17.TanspwtarAdnmNNgmmtplR.,Ira Mabre, <br /> mmpMerl PimteMyped Name N^ Y em <br /> 6 5 4 ZO <br /> ruspader2 Premd(P Name m Y mr <br /> ♦IEEE$ 1B.aeoaparcy <br /> I led,Dieaeper,lMiotlpn Spam ❑ oaddlH ❑Type ❑Reandoe ❑Permed Rajxukm L1 Fie Reackin <br /> Merdhat Relam me Number. <br /> 1W.PINmaMFadliry a Gemrebr) US.EPA IO Number <br /> J <br /> U <br /> LL FerJ ePhne' <br /> w 18c.Sinai driemete Friar Salami Monty Day Year <br /> 2 <br /> H19.Ha7ardms Wash Repan Menegema1l Metlptl Codas O.e.,mdpbhemMole;waMeaeeMNM,dbposal,eM recYctingsyskmsl <br /> t H132 2- 3. 4. <br /> 2o,Oaregnebd Fame Came or Operetm:CarNNmem d.01d hazardous matareh orrerad by Ne manifest evmpl me mted in and 1b <br /> Pr W,red NameT Synetore i Day Y. <br /> V IDS re— 64 11 IU <br /> EPA Farm 8700-22(Rev.3-05) Previous Editions are obaohle D SIGNATTED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> Glean Harbors has tire apDroprim¢oermi[sfor and will aeeeln the waste the Eeper ansslppm& <br />