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Please priMo�(Form designed to use an elite(12- bh) ' .) QM, 0703 SC PPW 7/12,'2018 ForrnA rayed.OMB No,2050.0038 <br /> UNIFORM HAZARDOUS 1.GareramrlD Number 2.Pageial ].Fmemerwy Response Panne 4.Manaesl Traaling Numhar <br /> WASTE MANIFEST CAL 0 0 0 3 5 91 0 2 1 (900)4833718 17 FLE <br /> 5.Mani NameandMail'mg Aa@ma Miami Ste Addreaa d diflwad Man mal,atldraSs) <br /> DTE Stockton LLC <br /> 2526 W.Washington Street 2526 W Washirdnon Street <br /> SWckton.:(20912320$700 ATTN:Genne Huffman Stuokton,CA95203 <br /> Gwcmc Wmm <br /> re Deny Namy US.EPA ID Number <br /> kit �' e r' eJ ,& 0 ?a <br /> ].iran 2 pany Name US.EPAIDNltrat <br /> e.0esgnded F.11,Name and Sim Address U.S.EPAIDNumber <br /> Clean Harbors Buttomdllo a LLC CAD 9 9 O G 7 5 2 7 G <br /> 2500 West Lokem Road <br /> Sumonwi ure.CA 93206 <br /> Fati1 's PNpnd (6611 7626200 <br /> 9a. 9b.U.S.DOi Dewipdon lirdudn9 Pmpa SNippNg Name.Haran Gau.ID Numpa, 10.Conm'mn 11.1dd 12 Mft <br /> HM and Paek'rrg Gmup(sanyd Na. Type Ouni A1JJpl 13.Wesco CDtles <br /> I UN1759,CORROSIVE SOLIDS,N.O.S.,(ARSENIC,CHROMIUM 571 <br /> It 9,PO III,BOTTOMASH) / A <br /> ac 2. <br /> w <br /> cp <br /> 3. <br /> 4. <br /> 11:C9134i63�bl�Inns and EYGi1.59tlpn <br /> Contract retained on,oenefa or EOmU9 aaeni authority on Initial lranso01te7 t0 add Of SUOStnme additional tran crotefa on Uenendors Genal( <br /> 15. GENERAT(At'SNFFEMR'SCERTIFICATON: 1he ydeclare Mat Necontentsdtiswnsignmmtare MlyaMxcurabtytlesvibetlaboveby Mepr rsipogw ,antlaretleWfletl.paskaW, <br /> mi and MbeIMlpMmrtled,and are In all respects in proper mndron ml lrargporl accordingm appllmde Nmmalloml and rail mrnmemal ryuleans.ll erpon idomenland l am etre P., <br /> Expam "a Nal immmm�lsduamain mnsgnmenrmniwm totM tamsd Me etrsNHEPAAcknoMetlgmentdGn+ent <br /> cekfytlatlM1e wante minimiaeha lemmAmNfiM In40 CFR E611)(a)nil am a Myequantily generaM)w(bl(tll arae Small quantilygenereblretrw. <br /> m me Dm ad <br /> `N `1 <br /> la,mearradminabirprilinaram ❑Impwtmus. ❑Erpadlmmus. Pal arra'all <br /> Tran miwe mr emam,arid Dare limi Us.: <br /> Go 17.TmnN am,,idtm edgmentd deacons <br /> in PrMm mad Name r mmY ear <br /> d M. 0907 <br /> ig <br /> Traminarml PnrMaFWNam iqm. my <br /> manC <br /> 1 1e.0Ssrem ay <br /> 118,.paaepenq lMimEon Spaoo ❑ D�nNy ❑Tyra ❑RmMpe El Poland Redadma ❑FuN Rajmada <br /> Mareleel RelMerxe Number <br /> 186.PMmem Fadfayiw Gwcmbtf U.s.EPAIDNUMa <br /> U <br /> LL <br /> FraffiNis Fume: <br /> 15c Sbmmm dNkmde Froady(or Gammla) MontiDry year <br /> Q <br /> Z <br /> h19.Haradaus Waste Rµwr Maraganent Matlwd Cptlea(Ie.,cedeabr NazaNpmxasre emanenN dspasal,andregtlim gdaml <br /> t- H132 2' 3. 4. <br /> 1 20.Dean Fatal Dimon,Mmamc Mrakrearamaiptd ha...dnas mamraMradbyM rannieampasmtau in Item laa <br /> Pan ypad Nam —n sprewre m 'mar <br /> J LIfI Dar A <br /> EPAForm a7U422(lo".3-05) Prelfiousiroaronsamoosomm DF(SIGNAIED FA ILITY TO DESTINATION STATE(IF REQUIRED) <br /> clean Harbors has the appropriate permits for and will accept thewaste the genefaor is s C. <br />