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SC PPW 7;i2/20is <br /> Please printortype.(form ' red for use on elite 12-pitch ewdler.) 7,-VV / FornrlAppvved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 1.Generator O Number 2.Pegs 1 of3.Emergency Response Phone C ManlfeetTraeldng Number <br /> WASTE MANIFEST CAL 0 0 0 3 5 81 0 2 1 (8001493-3718011974323 FLE <br /> 3,Generators Name and Mailing Address Generators tie Address(ifdifferem than mailing address) <br /> DTE Stockton LLC <br /> 2526 W.Washington Street 2526 w Washington Street <br /> Stadttoft.t j&R20 00 ATINfi>tennr Huffman 5todctfan.CA 95203 <br /> Generators Phone: <br /> f8rpadar U.S.EPA ID Number <br /> e�lecvmses <br /> 7 -ranspater 2 CompaTVasns r U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Clean Harbors Buttonwillow LLC nu no .. G-.5.. <br /> 2500 West Lolcern Road C A is a s+✓o u c r o <br /> Buttom willow.CA 93206 <br /> Facir s Phone: (6611762-6200 <br /> ga. 9b•U.S.DOT Deapiptien(including Proper Shipping Name,Hazard Clens,tD Number, 10.Containers 11.Totat 12.Un11 13.Waste Codes <br /> HM and PackingGroup(Zany)) No. Type Quantity WtNol. <br /> 1.UN1759.CORROSIVE SOLOS,N.O.S.,(ARSENIC,CH RONUK 571 <br /> o x S.PG III,(BOTTOM ASH) I �6 l <br /> Z 2. <br /> W <br /> 3. <br /> contract fetaineri by 3enerjicr coder men.k autl"c-1'� on 9nttlal transoorter to add or 5u=ltute acldlflonai transoorters on oerlerator"s 0z;,.ar <br /> 15. GENERAT0R'SWFER0Ft'S CERTIFICATION: I hereby declare that the cements of this oansigrment are fully and accurately described above by the proper shipping name,and are cl8sAW,Packaged, <br /> marked and labetedfplacanied,and are in all respects in proper condition for transport ectordbV to applicable Irnematiorhal and national governmental regulations.If export shipment and I am tine Primary <br /> Exporter,I certify that the contents of this consignment conform lo the terms of the attached EPAAdmhawledgment of Consent. <br /> I certify that the waste minimization stalament identirhed in 40 CFR 282.27(a)(f I am a large quantity generator)or(b)('d I am a small quantity generator)is Irus. <br /> Genvoloftm: REM <br /> --J) <br /> 18,International Shipmentaf <br /> F- ❑Import to U.S. ❑Export Irom U.S. of en !exit: <br /> Tram rter tnature exports o Date leaving U.S.: <br /> 17.TransporterAcknowNl;mertt of Reo*of Materials <br /> rdKVTYPW R;7* <br /> Day yes <br /> O ``''''��'' . <br /> a t Qe- VC.�1 vv1 ' ZD <br /> 1TransporW2PNntad1T-jp@dN9rns y Year <br /> F- <br /> 18.Discrepancy ��t1 <br /> lite-Discrepancy indication Space Quantity rrL]Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mardfest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facllit's Phone: <br /> C3 i8c Signature of Aliernate Facility(or Generator) Month Day Year <br /> U) 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous vreats treatment,disposal,and mcyding systerns) <br /> 1. 2. 3. 4. <br /> H132 <br /> 20-Designated Facility Avner or Operator:Certification of receipt of hazardous materials oavored by the manliest except as noted in Item 18a <br /> lanntrdfryped Name k- Day <br /> '--7—es rt bei � o9E27-01 <br /> EPA Form 8700-22 (Rev.3.05) Preyious editions are obsolete ne F + .ally !"rtp F� ILITY TO DESTINATION STATE(IF REQUIRED) <br /> Clean H arbers has the appropriate perfnsts For and will atcepi the waste ege <br />