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Please prim of type.(Form desIgned for use on el" (1&pitch)typewriter.) FonD Approved.0118 No.2050-0039 <br /> UNIfORM HAZAR000S 1•IGeneralIXlo N'amber 2.Pagetol 1EmergencyResponse Phone 4.Manilas)Trackln9NuI <br /> WASTE MANIFEST CAL 0002139375 1 000)424-9300 032426123 JJ K <br /> 5.Genarale/d Name senthl gMdruss Genualo(s SiteP.ddreu(il dfierenl Uan masn9addressJ <br /> PICK N PULL 880 <br /> 3927 CLARK OR 3927 CLARK DR <br /> STOCKTON CA 95205STOCKTOM CA 95205 <br /> Generatoh Phono: 916609-2000 <br /> B-TranspateslCompary Namo Wi _ .. "" U.S.EPAIDNumber <br /> ASBURY ENVIRONMENTAL SERVICES A%28277036 i <br /> 7.LanspoMr 2 Company Name U.$ Number <br /> &Oes!tfu FacwtyName and SneAdd(ess .EPAID Number <br /> 7300ICHEVRON WAY ENVIRONMENTAL HEALl�I ' <br /> DIXON CA 95620 DEPARTMENT <br /> FaE1 s Phone: (707)693.6000 A T 0 0 0 012 G 0 2 <br /> 9, 91%U.S.UOTDesupfan(intlW:y Proper SWOg Name.lfwam Cuss,ID Number, IO.Conla'ners <br /> and Packl Grw fa II.Trial 12.Unll 13.Waste Codes <br /> H61 n9 PG m')) <br /> he Typo Wan9ry {@Not. <br /> a NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL) 00:1 T G 221 <br /> I <br /> 2. <br /> all <br /> 0. ;.. ....I__... I.. <br /> 14.Spedal Hoollyg lnslN(COas and Add6wl lnfolmafon <br /> NAERGR 961:171* PROFILE 8 9B1:DK100184 EMERGENCY CONTACT:CHEMTREC 1-900.424-9300 <br /> ADDITIONAL EPA CODES:9B1:,NONE*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'$IOFFEROR'S CERTIFICATION:Thereby dttrara that the conknlsolWs coninn,am ar aMa(araleydes(nhedabova bylhe proper sh`pp'ay name,and are dassif.(d,packaged, <br /> marked and uWed'placatded,and are hal respects In proper condEan WbanspaAaccadirg to app!ocab!ehlernayanaleM na[asei yavemmenul se s.)(expel sh'gnent and l am 9ce Primary <br /> Exporter.fceo Wal Wetonlemsol W's cons'grrnenl confamta lhelermartIN a11a(had EPAAckwa!edgmenlo s M. <br /> 1(eflifylhal We waste mn'ml al'onstatement ldxd6fedrn40CFR 26227(a)(diamaluge quanay ge a! IX )(fl m m g rat sura. <br /> GereralotsYy eme3Pd edRyped Name1 h.onW Day Year <br /> C a <br /> —1 1&Interne" a SMpne s I <br /> Impmtto U.S. ❑Export! mU P ole ,us <br /> i <br /> Transporter synalure(for exports only): Dalek U.S.: <br /> 17.LanspcderAcluw!*nw4 of 10IIIaleriae <br /> K Trans d tedTyped Na ' <br /> 5:n lure month Day Year <br /> a wtL Z <br /> Trans 2PrinlaNfypeO Name S:g a A!onW OXY War <br /> I <br /> 18.Usttepanry <br /> I8a.Dso*panglnxFoation$paca El Namay ❑Type ❑Residue ❑PaNzl Rejection ❑Fu7 Re;eaon <br /> I.sani!est Relefenw Number. <br /> IBb,Nlemate FaWry(a Generator) U.$.EPAID Number <br /> J <br /> U <br /> a Facitws Phone: <br /> aw IBC SgnaNreo Agernala Fao3ry(orGeneralaJ A!mW Day Year <br /> T <br /> 19.14aaardous Waste Report management meow codes(I a,codes for haza(dous wase treabnom,cdsposak and recydlre systems) <br /> p 1. <br /> 29.00Sk3wled Faddy l)AnOfIXDPeralOr:DerCfCdl'an0lrttetp101 tardWsmalonas N'ttfed by We malYfest except as Ached In Re 18a <br /> Pfmlcdr7yped Name Sgnalure h!onW 0a ear <br /> 11 e' ll /�l/ alY- Dt( <br /> EPA Form 8700-22(Ray.3.05) Prevlous ediffons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IP REQUIRED) <br />