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Pleese priw or type Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Geri,erAlD-dU66028-5262 <br /> �b�r0 S 2 2 2.Page]of 3.ErOg[gg45y$�3nnse Phone 4.ManlfestTrackin Number <br /> WASTE MANIFEST LL FF�d UU 9 4kJ�i1i 1016134872 FLE <br /> 5.Genal&AarM ftd rfta—now-STOCKTON Gep&A_VI3 eftbdgb1 J ft (Ing address) <br /> 1325 EL PINAL DRIVE 1325 EL PINAL DRIVE <br /> STOCKTON CA 95205 STOCKTON CA 95206 <br /> Generators Phone: 408 988-8642 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> =CLEAN HATARDOUS WASTE REMOVAL,INC. C A 0 9 8 2 4 9 2 3 9 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Na�'my NEADAAddress U.S.EPA ID Number <br /> HWY.9511.MILIES SOUTH OF BEATTY <br /> BEATTY NV 88003 <br /> ���., NVT330010000 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> RQ,UN3264,WASTE CORROSNE LIQUIDS,ACIDIC,INORGANIC, t <br /> O X N.O.S.,8,PG II(SULFURIC ACID.ALUMINUM) 00ci" DF Li G <br /> w <br /> Z <br /> LU <br /> O <br /> 3 <br /> 4 <br /> �+ <br /> 14,41C1�Ij2 ���� �60ANNENT SLUDGE <br /> -ACHWO1M12i12l19W-C9"BILLTOALL CLEAN PO/IM". <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 governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to[lie leims of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generatofsf0fferor's Printedfryped NameSi,nahxe Month Day Year <br /> J 16.International Shipments <br /> F ❑Import to U.S. El Export fro .S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date learing U S.. <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed ypad Name Signature 7 MonF�z Cay Year <br /> O <br /> a <br /> z Transporter 2 rimed/Typed Name Signature RMonth Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity F—i Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> C.) <br /> ta+- Faculty's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day near <br /> a <br /> Z <br /> V5 19.Ha ardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w2. 3. 4. <br /> D <br /> 20.Desig aced acZlfy Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdnVqFFyped NameSig Month Day I'M rw VY].OL(t4" I A I Q)Z U' <br /> EPA 1 arrn 700 IRev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />