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302 N Cherokee Ln, Lodi, CA 95240 PR0513602
<br /> 03/02/2022 Program: HW
<br /> PHOTO 1:
<br /> Miss*n final copy of manifest signed by the desig j ed facility. CORRECTED ON SITE
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<br /> WA87E NANIFEeT(a ' maw iD lWnt¢r CgL000005483 2.Pap;W 3 E p° meg Form APProred.OMB No 2050-0039
<br /> °e yt (G 1 1 0 -458_1760 i.11an-Trackup Nump,r
<br /> 5 Generalo/a Name vM MaArN Addmaa SKS
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<br /> 302 N Chrroker Ln
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<br /> G"'^'aiora vlwne CA 95240-2401
<br /> %a � 6 Tranym«
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<br /> Ty- LEEN SYSTEMS INC U.S.EPA ID Numper
<br /> auan^ r Trenspode.z comwur Name T 1(R0000B 1205
<br /> SNeya CLEAN HARBORS ENV SVC INC. us.EPA I5 Number Date Generated:11/18/2021
<br /> e-0')rnY11S, e.Despnabd Faulrty Name end Si4 Addres`433-894-9100 NO
<br /> CLERK HARBORS
<br /> MAD03932225o
<br /> MUT14 A EPAlo ARAGONITE, LLC us. rvemper
<br /> 11600 PTUS ROAD
<br /> Manifest Number Generator
<br /> ARR60NITE , U.I. 84029
<br /> � Fadu aPnone� r�-006952026SKS CAL00000
<br /> y1/ ea, ab.us.Da Groop pony nnavdm lJTD9B 1552177 —007439436SKS CALOOOOC
<br /> u^iey� /I NM riot ParY'iq Gmup(Aany)) gproper Shppinp Name,Karam Class.ID Number, 10.ConUiners
<br /> 1 11.nlity.tai 12 Unit �007758813SK5 CAL0000(
<br /> u^a t N0' TYPO Duanlity WINoI. 13.Waste Codes
<br /> sfuuap X NA3082, HAZARDOUS LEAD), 9, PS + 07758814SKS CALOOOOI
<br /> ay(v (CADMIUM, LEAD), 9, PG 'III J11 G DD0 D007 D00B 0160515841JK
<br /> a3kaD a3;,grsN w 2 CAL0000
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<br /> oy PR(3yf aMYc ( I Ay1 14,Special Handling lnsouclions and Adtliaonal Information
<br /> a�aLd 9 3o3p o P nr'TNp 1 TSDsAG 82597139 BIIG849
<br /> 43 g d�ola 1)ERG$171 gg C5G t
<br /> 24H E(hERGENCY#800-468-1768—CH/SK/TFI—Contract retained 6
<br /> 3ru-30a 0 °jfanur'+ (^a(ra �Y1Oo'uaaa`�+as °•w-a 15. GENERATOR'SLOFFEROR'SCE IFICATION:thereby1`2 to -,i l that the T y generator confers a ency authori y
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<br /> 1 Pur�suoliw 4""aLM aya 3^ pZ`•7TMJ as++°14a,�q Genereto/s/O eroNs PnnledRyped Neme tatement identified in 40 CFR 262.27(a)(iflamalarge quantity generetor or fl am a small quantity xlf itessr lv]uasa+eaL3`f4-115 dui 3sijlaapar'�M�aDalq 1 (It' tygenerelor)iS true
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<br /> 17.TrareponerAcknoMiadgrrrenl offteceipl ofMatedals Data leaving U.S.:
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<br /> Manifest Reference Number:
<br /> 3S aV3 oluc ix—lsgns 6ucuuoiuoa-uou iur a+npojiui l J
<br /> —46r+au 4- '—L sins aLgrn Lddr put 11'292 ¢ U.S.EPA IDNumber
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<br /> stns j} fi., fsnL3 61+ado+d-1aLgc suodsa+sr LS 18c Signature ofAllemate Facility(or Generator
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<br /> /pyr u'a/ois '1da3�r3 3 pad Luuraa Lsf Pur i3FJ°dr3 F o 119.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
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<br /> 6 +a 3 L-�l 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted In Item 1Ba
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<br /> ^' •"" '"•" Forrs18700.12(Rev.12-17)Previous editions are obsolete.
<br /> 16/828237 GENERATOR'S INITIAL COPY
<br /> VICKY VANG-LEE, REHS Page 1 of 6
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