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that no m3tell31 Change nge has occurred either in the Characteristics at to the process generattng�o�r�i pe',ead. OMB No. 2050-0039 `Generator acicnaadiedges 4. Manifest7racking Number Please print or ty e. 2. Page 1 of 3. Emergency Response Phone 1. Generator ID Number (8001483-3718 014788828 F L E FiNIFORM HAZARDOUS L WASTE MANIFEST CAL 0 0 0 4 2 0 ' Generetol s Site Address ('d different than matting address) 5. Generators Name and Mailing Address Stockton Dena Resort, LLC SAME 14900 W Highway 12 Lodi, CA 95242 GeneratorsU.S. EPA ID Number Phone. ( 0 6. Transporter 1 Company Name A 0 Clean jHarbors Environmental Services- Inc- 7. nc 7. Transporter 2 Company Name i - 'i1 Contract retained by Generator carders 15. GENEpATOR'glDFFEROWS CERTIFICATION: (hereby declare that fire contents of this consigriment are fully and accurately aescnoeo acrove °r ++'=raw' ^•rY•••s "-' -' 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdmoWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (d I am a smalt quantity generator) is We. Month tDay Year Signatu /] !1 / l 20 Gene �r'sl0fferors PriMedlTyped a`me J 16. tntemational Shipments❑ Export from U.S. Port of entryleAt: ❑ Import to U.S. Date leaving U.S.: LE Transporter signature (for exports only): w 17. Transporter Acknowledgment of Receipt of Materials LLI Transporter 1 Pdritedlwed Name o //JIT+ -Z f44 - i i Ah Dav Year 18. Discrepancy Type Residue ❑partial Rejection Full Rejection 18a. Discrepancy Indication Space ❑ Quantity Manifest Reference Number: U.S. EPA ID Number 18b. Altemate Facility (or Generator) J G.) Month Day Year I Facility's Phone: LO 18c. Signature of Alternate Facility (ot Generator) a Z r e codes for hazardous waste treatmendis sal, ant, d recycling systems) Po 9 19. Hazardous Waste Report Management Method Codes (- 3 4, O 1 2y H 141 20. Designated facility Owner or Operator: Certification of receipt of Nazar us matedals covered by the mSn'rfest erxece t as noted in item a M Day ear 01 Pyp Na EPAForm 8704.22 (Rev. 12 7} Previous editions are nbsoiete. DESIGNATED FACILITY TO EPA'T SYSTEM s a -MA 1FE5 rt an Harbors h ttse appropriate sere o s ttand tld111 accept the waste the generator is shipping. w-5 ?nAi �}7 Iri74 i1 ? PPViI U.S. EPA ID Number 8. Designated Facility Name and Site Address C 14 D 0 5 9 4 30 Clean Harbors San lose LLD 1021 Benvessa Road San Jose. CA 95133 . Facility's Phone: 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers No Type 11. Total Quantity 12. Unit 13, Waste Codes Wt.Nol. ga HM and Packing Group (if any)) DOLS 343 NA3082- HAZARDOUS WASTE. LIQUID. N.0.5.- (GASOLINE. OIL Ill TP j bOQD f x AND WATEF& 9. PG l LU 2. niA3d72 �45r� �iQu,t7 a r% Cj Cy AS VL -me 0 !L ANS Ik 12F,2- - 3. r i - 'i1 Contract retained by Generator carders 15. GENEpATOR'glDFFEROWS CERTIFICATION: (hereby declare that fire contents of this consigriment are fully and accurately aescnoeo acrove °r ++'=raw' ^•rY•••s "-' -' 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdmoWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (d I am a smalt quantity generator) is We. Month tDay Year Signatu /] !1 / l 20 Gene �r'sl0fferors PriMedlTyped a`me J 16. tntemational Shipments❑ Export from U.S. Port of entryleAt: ❑ Import to U.S. Date leaving U.S.: LE Transporter signature (for exports only): w 17. Transporter Acknowledgment of Receipt of Materials LLI Transporter 1 Pdritedlwed Name o //JIT+ -Z f44 - i i Ah Dav Year 18. Discrepancy Type Residue ❑partial Rejection Full Rejection 18a. Discrepancy Indication Space ❑ Quantity Manifest Reference Number: U.S. EPA ID Number 18b. Altemate Facility (or Generator) J G.) Month Day Year I Facility's Phone: LO 18c. Signature of Alternate Facility (ot Generator) a Z r e codes for hazardous waste treatmendis sal, ant, d recycling systems) Po 9 19. Hazardous Waste Report Management Method Codes (- 3 4, O 1 2y H 141 20. Designated facility Owner or Operator: Certification of receipt of Nazar us matedals covered by the mSn'rfest erxece t as noted in item a M Day ear 01 Pyp Na EPAForm 8704.22 (Rev. 12 7} Previous editions are nbsoiete. DESIGNATED FACILITY TO EPA'T SYSTEM s a -MA 1FE5 rt an Harbors h ttse appropriate sere o s ttand tld111 accept the waste the generator is shipping. w-5 ?nAi �}7 Iri74 i1 ? PPViI