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Plr;m o9 ¢r ackilt Wedges that no material change has wxurred either in the cnaractensti"or In the process generating�r .OMB No 2050'm <br /> UNIFORM HAZARDOUS 1,Gateralor ID Number 2 Page 1 of 3.Em4ergmtcy Response Phone YanHes!Trackhrg Naaber <br /> I �� GA0990996105 900 483-3718 1 015233493 FLE <br /> 5. 8 G Gerx3ramra Me Address(If Mererr!Ow mamng address) <br /> cG as SWUM c o-OAKQALESC <br /> Pacific Gas&ElectricCo-Manifests PO Box 7640 OAKDALE SC 811 West'!"Street <br /> San Francisco,CA 94i20 Oakdale,CA 95361 <br /> Gertmatm.Pbotre:(92M 5iS4750 ATTN-C Iia Baraias <br /> S.Trmisporter 1 Company Nemo U.S.EPA ID Number <br /> Clean Harbors Environmental Services.IInnr MAD 0 3 9 3 2 2 2 O <br /> T.Transporter 2 Campmry Nam / 7'r /y2 U.S. <br /> ��IEPA ID Nwnber <br /> O® `��� P <br /> 8.Designated FaAy Nana and Sits Address U.S.EPA ID Number <br /> Clean Harbors Grassv Molmtain LLC U T D 9 91 3 0 17 4 8 <br /> 3 Miles East 7 Miles North of Knolls <br /> Grantsville,UT 84029 <br /> FecM y's Pare: <br /> ga 9b.U.S.DOT Desaipdon 0x uding Proper SMppbv Name.Ha-d Class,ID Number, 10.Corez6mm 11.Toml 12 Unit 13.Wasto Codes <br /> HM and Paddm Group(If-y)) No. Type wuvol- <br /> a 1iYON�CRA HAZARQOU51RlASTE,SOUR,(OILY DEBRIS) 001 R M 00150 P 352 <br /> z. <br /> 3. <br /> 4. <br /> Y. Won' Addtnor,ai wr> 1855 <br /> alLanoContract felalned bq generator¢gtlfer6 ageriC <br /> rly on Ifrdlal transAvrter to add or s1rDsttiuute addfi!¢nal trdn iters an Y o <br /> 15. GENEAATORWOFFERORIS CERnF CATION:I hereby dedae OW Bre owdonts of this cmOr sM we My and aaauately desmbed above by the proper sNpp l nam.and are dasstfad,packaged, <br /> otaked and fa*:Wplacaded.and am In ell mspectS In proper oon&W for hanspmt aocordhtg to al*%able b>tmnmiirmelad rmtiona!govmmn-W MgNaftls.It export sit m-d and I am Bte Prlmmy <br /> Esq)rter,I W* Bre oonterds of ft oonaignmerd cordarm to the trams of Bre dachod EPAAdato Mlgmmtt of Consernt. <br /> I ofif them the wasm tt ftizabon otat~wended to 40 CFR 262.27(a)(d I am a Inge qure2y gems 4m)or(b)(a I am a arae➢quantity gen-tor)Is mute. <br /> GenaaWs.`Of ees Printed fT ped Name O T jdcAlf Mord Day Yea <br /> '70.L d tC PSE l6 20 <br /> 18.Into nwkrlal Shonenfs <br /> ❑Import to U.S. El Export from U.S. Port of e00dl: <br /> Trmsportar sgrtahue(for-ports only): Date leav+g U.S. <br /> n.Transporter Aa CWWgmerd of Reoefpt of Matadors <br /> a Tmnspatm PrfttiedTyped a <br /> Signahae Mordh Day Year <br /> gZA Mort Day Yew <br /> I W. <br /> 9^ <br /> N Trmtsporter 2 NamQom- QI 7 2d <br /> 18.Dlsaepatcy <br /> 18a Dwepartq Inftaton Spada ❑ qty ❑ ❑Residue ❑P.W Rgpafion ❑Fu1 R*cboo <br /> Mmtlfest Referertoe Number. <br /> 18b Amite FaclBty(e Genmutor) U.S.EPA ID Number <br /> V <br /> FaaWs Phx*: <br /> 180.Sigmttrre of Man=Fao y(or Generator) Year <br /> 19.Hazmdous Waste Report Management Method Codes p.e.,codas for hazardous vmste treat disposal,end regclfrg system) <br /> 1 H13Z z. 3.Lu 4 <br /> 20.Designated Faddy Ownm or Operator:CKMC85M Of re 80 of htamdas ma rb*wm*ed by the manAest except as tided In Item 1 B <br /> Prmtud,ffWyd Name STM' th <br /> EPArro 1z-1 Previous misers tete. Dg ATED FACILITY 70 EPA <br /> e-MANIFEST SYSTEM <br /> e rl has to appr¢prla a pelm 6 or and will atxept ttte waste the generator Is sh PP 9 712005653873 PPW <br />