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Please print or type,(Fan designed Muse on elNe(12-pft)typevner.) 2,ODJ SC PPW 7/12/2016 Fan Approved.OMB No.20%W39 <br /> UNIFORM HA7AR0003 I.GmerahorIONumba 2.Pagel of 3.Emergency Response Rare I.ManReM Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 3 5 910 2 1 (900)49&3716 FLE <br /> 5. hofs Name and MailingA on, raraw.Sho Pdtlrex lRtliMaiaNCan mailing all <br /> DTE Stockton LLC <br /> 2526 W.Washington Street 2526 W Washington Street <br /> st"ClatoD 1.Deno Spackton,CA 95203 <br /> peeraa,,Prep;W0'M3700 ATTNGennr Huffman <br /> sport« anpaMM uS.EPA ID Numicx <br /> K QJ Cc ✓ 1 <br /> 1.Tmrsporb Cwmmy Name US.EPA IDN0 <br /> B.Poeynalre aulih Nmre aM Site Adtlres6 US.EPAIO Number <br /> Clean Harbors BMtmnwillow LLC CAD 9 8 0 6 7 52 7 6 <br /> 2500 WestLakem Road <br /> Suttonvo llow.CA 93206 <br /> Fad SPh., (661)762.6200 <br /> ga. 9b.05.DOTDesmpgm linawirG Pmpa SNppirg Name.Hamel CMss,ONumber, 10.Camawn 11.TOG 12.IM0 <br /> HM aM Petldrg CmpfilaMl) No. Type 3 <br /> GuYAM. 1 <br /> a AN VFxN Latlas <br /> 1 UN1759.CORROSIVE SOLIDS,N.O.S-,(ARSENIC,CHROMIUML 571 <br /> X 6,130111.(BOTTOMASH) AT Ln,lw r��/ <br /> i 2. <br /> w <br /> AG <br /> 3. <br /> a. <br /> 11.Specal HaMbyy NSNaRms aNAAtlNaW lnlamalion <br /> 1-CH]398980 EYGaf159 <br /> transporter to add a,soetwe addnionji transporters on aen,rators Derr <br /> 15. GENERATOR'S'OFFEROR'SCERPFICATION: IM1erebY dedara Nal Neamlents of Nis mnsgnmenlare Wlhand sauralNytlesaibetl above byltapmpersMPWrS reme.aik areclassifetl.pa¢Msgatl. <br /> manedand labdedrpacaNed,and me in au mepecm m aocermroibgn sw banspon orating roapplimbla mmmaoaal and mbaral g rrenul reggMUam.RmponsNgmentand l am Vce Primary <br /> lmr*r t ft NaINe¢Menbol OmenspnnenlmnfomiNNe cerins 01Ne ald'Jmd EPAAGnMAetlgmenlglCmsenl <br /> I ceNhtlNl Me wash mNimUaOtvi wl¢ment q¢npfied In ap LFR262.2]Ia11A I am a larye quan4h ganaedr)or)bl ltll am a 6mall quanYty gaerata Is We. <br /> m am0 a mMan <br /> ay Bar <br /> T 4 20 <br /> v 16.Inhometional SM1l b <br /> 2 ❑ImpoRa DS. ❑EvpMhwn 05. P tenby R; <br /> Tldn6 narnm bIBY MI Dale lOavi US'. <br /> IK ti.Transpwler AcknwAedgmaldRereylolMNera§ <br /> cnoa doer l Pro ypae Name y .r <br /> ti V IG ac tae /y 'N.i 4 70 <br /> gne <br /> z� Iai6ppner2 PonteMYped Name m yoear <br /> 1FS ia.UeeBpmi, <br /> I 1Po.Obxepanry lntimAm Spam ❑ Uve" ❑Type ❑ResMm ❑PaNMRapcica ❑FYA Rejection <br /> MadMsl Release Number <br /> 18b.ammaNFaawry(a Dererahorl U.S.EPA ID Number <br /> U <br /> Q <br /> w Fati sPlme' <br /> Maj 16c Sgmaue BlApmmm Faddy lm GamabrJ SbnN 04 y� <br /> Q <br /> S2 <br /> 19.Ha'eardoic Waem Repod Maiagmanl MdMd feriae li e..modes fix M1azadoua waste lreabranl di6posd.mer�H'ng sysRms) <br /> Ea 1. 2. 3. a. <br /> H132 <br /> 20,0"rated Fadih Olma Pr0uaM LeNfi®Aon olrecdploflat&tluaama4riab rorrereA by Ne manileslexttplas noted in Ibm 16a <br /> 1 RnRM Name <br /> YP6d gnawre kmnai PoY Year- <br /> . a^r� Oat O$1 zo <br /> EPA Farm 8700-22(Rev.345) Previous edRions are obsolete. DESICsNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> Clean Harbors has the appropriate permits for and will accept the waste eEenerat0 is sT 1pplat <br />