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Please print or lype.(Fomr 1rserneil for use on elite(12•pivat)typewriter} Form +ppi., _.I OA18 No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Humber <br /> WASTE MANIFEST CAL 0 0 0 2 6 9 3 7 5 1 (800)424-9300 017791931 JJ K <br /> v.mir r.anrc rvirna.0 al td,w.ri•,p A r l c GeP.enlor's ShAddross(If diffemnithan iNil! ad are+:.I <br /> PICK N PULL 080 <br /> 3927 CLARK DR. <br /> STOCKTON CA 95205 <br /> Genoritnr';s7,onp. 209 462-1927 <br /> i.lran pedes t Unmf 7r Nemo I.I.S EPA to Numin( <br /> ASSURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Noma U.S EPA ID Nu il)or <br /> B.Desigr_W9 Fadlity Name and SiteAJrd,r!ss U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICE-CERES <br /> 1920 MORGAN RD. <br /> CERES CA 95358 CA 000393680 <br /> Facilitv's Phone: (209)541-1825 <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL) 221 <br /> 0 <br /> 001 TT '60 G <br /> 2 <br /> z - —_ — - lJ <br /> LU <br /> 0 <br /> 4 <br /> m 5}iccii!Handling Inslructions and Additional InformaWn <br /> EMERGENCY CONTACT: CHEMTREC 1-800.4249300 *P ROPRIATE PERSONAL PROTECTIVE EQUIPMENT-EMERGENCY <br /> CONTACT CHEMTREC 800-424.9300 -TRUCK# <br /> 15, GENERATCR'SIOFFEROR`S CERTIFICATION:i hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,paAged, <br /> 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 <br /> Exporter,I certify that the contents of this cwnsignmont conform to the terms of the attached EPA Ackraow1odgmeni 9r ot. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantlty garevrator )diff ffi a small quantity generator)Is true. <br /> rxxtsmdar ffdtoi+YfkKy1:VdNF111`11 - �� V .V c Sin a I//J rnufY :Iry nr <br /> it <br /> _J 16,Womatlonal Shipmenl6 <br /> iH ❑Import to U.S. ❑Export mut U.S. Porta .Ir(' <br /> ? Transporter signature(for exports only)! "pate leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Ir1rt p+.,t+u f I ilrlA•L f);^3 N:ury ) 6 +r hrDay <br /> L Year <br /> p <br /> QTransporter 2 PrinledfTyped Name Signature Month Day lear <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space I ! r El Re' <br /> LJ Quantity L]Type ❑Residue _..�Partial Rejection lection <br /> fAaralitsfRofararrce N+mtber <br /> 1Bb.Adtarra a Facffily fa,Gr rwj• ilcrl U.S•EPA ID slumber <br /> J <br /> U <br /> ua f-cilily::Phone: <br /> w 1 Bc.Signature of Alternate Facility(or Generator) Moa h Uay Yser <br /> a <br /> Z <br /> m19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Designated Facility Owner or Operator:Certification of recuipl of hazardous materials covered by the manifest except as not d..It 1 n <br /> Nnrr,M!;Ty •}IC,m, ;i:ns!t;ur N4nrh Day 1'c:u <br /> EPA Form 8700-22(Rev.3-05) Previous editions are cdsolcle <br />