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,i7, a na, x..,l- ,, _ rq -a 's?:: :r f'r? T 's6 generat>t <br />please Dnnt or twe y+ �Ofrll ADoroveif. OMB No. 2050-0039 <br />€ <br />UNIFORM NAZARDous <br />1- Generator!) Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />g y <br />4. ManlfestTrackin Number <br />g <br />j <br />WASTE MANIFEST <br />E <br />C= A L (j = '}3 '3 <br />iC34]l3-3 e `i 3 <br />014788830 <br />FLE <br />5, Generator's Name and Mailing Address Generators Site Address (if different than mailing address) <br />Stockton Delta Resort, LLC. <br />14900 W Highway 12 SAME <br />Lodi, CA 95242 <br />Generatofs Phone: ('2091369-04 1 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />Clean Harbors Ernrironrnental Services, Inc- M A CJr 0 3 .9 3 2 2 <br />7- Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />Clean Harbors Environmental Services. Inc. <br />Al C n Qq _, � „ r, w -� <br />2247 South Hi9bwav Tl Ir L •. r a <br />F r'0140t:NE sSIL45 28 <br />9a <br />9h. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HEJ <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nn" <br />i <br />UN1325. WASTE FLAMMABLE SOLIDS, ORGANIC:., H-0.5., <br />(ABWRBENT SMC ONTAMIHATED WITH GAS AND 011-1. 4.1- <br />Z <br />2. <br />LLJ <br />3. <br />4, <br />14. Special Handling Instructions and Additional h�nfoorr�m}alion <br />4_CH1965352 a4x- <br />Contract retair pa Dy =7enerzil larders agency <br />15. GENE€2ATOR'SIDFFER0'WS CERTIFI A I N: I here y declare at a Conten o t is cansignme are Iy and aaeura Iy escn abCve y the proper s 3pping name, a are c ass' e , ' aged, <br />maNed and labeledfpiacarded, and are in all respects in proper condition for transportaccording to applicable internationaland national governmental regulations. if exportshipment and I am the Primary <br />Exporter, I certify that the contents of thls consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 413 CFR 262.27(a) (if I am a large quantity generator) or (b) (Ifl am a small quantity generator) is true, <br />Gen torsio ferer's Print !Tp ame Signawn Month Day Year <br />fry tk) � <br />F <br />f 6 Intematior4 Shipments <br />El Impert to U.S. 1 Export from U.S. Port of entryiexlt: <br />? <br />Transporter signature (for exports only), Dale leaving U.S.: <br />tr <br />17, Transporter Acknowledgment of Receipt of Materials <br />TransporterIPrintedrTyped Name Signature41 Month Day Year <br />O <br />77 <br />i G l <br />Transporter 2 ?rnted;Tyoed Name Signature Month Day Year <br />aZ <br />F- <br />ib. DISGrePanCy <br />13a. t]=scrapar.-'V sw'e <br />L— Quantity L J Type Redd°se p J , artial Rejection Full Rejection <br />t,,larres� Reference Numberj <br />I�] <br />�I <br />I <br />`C±] <br />`....�....`......-�...:_�:�_._......_ lam_-e-�_,. of v0+��5 �,c� J]•-.-...w..,.�_....:__...��_lJ i,-^.._`-� <br />