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GY?3C2 <br /> Please prfnt or type.(Form designed for use on elite(12-pitch)typewriter.) SC PPW 1Q/iQ/20j7 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 4R-4-471 A 1583 FSE <br /> 5. nerator's Name and Mailing Address Ge erator Site <br /> DTE Stockton LLC Address(f d ffen:nt than mailing address) <br /> 2526 W.Wash on Street 2526 W WashibMin Street <br /> Generator's CA 95203 Sfiuideton,CA 95203 <br /> 6 spoiler 1 Company Name U.S.EPA ID Number <br /> Q : 53,E <br /> 7.Transporter 2 Company Name U.,'$ EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number {6 <br /> Clean Harbors Bu tonielilloslr LLC F <br /> 2500 West Lokern Road Cl A ED 9 9 0^v 7 5 2 7 6 <br /> F;R~Uow.CA 93206 d <br /> 9a 9b.U.S.DOT Description(mc uding roper ipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> H'N and Packing Group(if any}) 13.Waste CodesNo Type; Quantity Wt,Nol. <br /> 1. <br /> NDN-RCRA HAZARDOUS WASTE,SOLIDS.(FLY ASH) Z�q� <br /> GL u s • <br /> 0' <br /> :• 2. 3 <br /> u� <br /> C) <br /> �I <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information <br /> t_CE6417535 <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper Condition for transport according to applicable international and national gove rnmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. <br /> 1 certify that the waste minimization statement identified in 44 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small qual generator)is true. <br /> eneratorslOffer 's PrinledlTyped Name b1gnaturL Month Day Year <br /> 16 International hipm is <br /> fN <br /> �• Import to U.S. ❑Export from U.S. Po of en exit: _ <br /> 2' <br /> Transporter signature Lbr exports onl Date leaving U.S.: $" <br /> 17 Transporter Acknowledgment of Ill of Materials <br /> �; Trans orter 1 Printed typed Nae Signature ort ay Year <br /> Z; Trzrispodill 2 Print&!(Typed Name Signature Month ay Year <br /> 16 Discrepancy ?, <br /> F <br /> 1&a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection �I <br /> Manifest Reference Number: #I' <br /> 181).Alternate Facility(or Generatar} U.S.EPA io Number <br /> J Fi <br /> V <br /> LL <br /> Facility's Phone: <br /> w 18r,.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. . <br /> H02 � <br /> 20.Designated Facility Owner or Operator:Cerl'dication of receipt of hazardous materials covered by the manifest except as noted in Item 18a __ <br /> PrliYedlTyped me Signature Month Da Year <br /> // C d <br /> 1 0 11,117 Lee <br /> EPA Rdmf 8700-2 (Rev.3-05) Previous editions are obsolete. DIl Ef FACILITY TO DESTINATION STAYE IF REQUIRED) � <br /> Clean Harbors has the appropriate permits for and will accept the _ or is shipping. "' <br />