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C!R17NNON TIRE <br /> P.O.BOX 1988 Form Quad.OMB No.2050003! <br /> STOCKTON,CA 95201 Pbase pont a M.(Form tlesMned for use an elite(12-pildl)typewritg(.) <br /> 1.Giewbr ID NwnMr - 2 Pape 1 d 3.Errwgway Respwne PMre 14,1111T racam8 Nrunbr <br /> '�j� UNIFORM HAZARDOUS <br /> -1(•r r.r.�.COO 3730 N.Wilson Way 4905 Claremont Ave. `�•- WASM MANIFEST Llk4 ioi-k11 JN t rlrs 7;}�.?','S `d t1 !}:- „t1 V F�E <br /> StoCkto,CA 95205 Stockton,CA 95207 - S.GmemWeName ardlaairlgAWmss carremWasMAadau(ndlrtarmtlnm pa"adiess7 <br /> PH(209)467-0154 PH(209)477-9000 a Q f GUM;;*INnarcfw{�+r4aaee_1r <br /> FAX(209)644-4443 FAX(209)477-5742 M 47511 N slarNaimb 5,1 <br /> 5 ca4virai C:A 9 FJL <br /> wl¢ra <br /> I GW,Ph...20-R-40-1:'17 <br /> ` 6 Transporter <br /> i*0-!1 ,Name U.S. Lw <br /> .EPA ID mb <br /> ;Y,st AT,v flneThita( k`r. . <br /> O7.TdnVarter 3 company US.EPAwrimna r <br /> vM <br /> ZA <br /> rn --S9r F:a�a3yly Nitre andSIIe Atldase U.S.EPA ID Nurrbw <br /> a K CD GFI;Ui57 tvnMfia lot <br /> t..dn ,'!tulNar 6:ee11tr MV?'.f.'fA:ffsuG <br /> Q ( ' E)Awiy,1+n/f fUCi« <br /> Facal'ePhone G..-r�•. <br /> 10.Gtnminera 11.idal 12.Un1 <br /> n�111� 9a 9b.U.5.DDT Oaswipbon(YrWdrrp Pwpar SNppbhg Nana.Narad t7 a1D Numbor, 13.Nhak Cures <br /> ^� WPodip Gwp(Rirytt No. Type GuaMy `MAU. <br /> M <br /> z 41- <br /> [� 3' RRtS474ltli�ni5l�?,.; -,:;Itiq:�'!lkFVh"!' } l1� rat <br /> 1a ® tf <br /> 11.Spnoal Hm&V Im1p,r5mx aur Addlbpal ldnrmaaap <br /> iaryn:+,tAs*r..a T7 4' l-fet:.Y.t P P O.+ST;4tr <br /> 15. GENERATORWOFFEROR'SCERNFICAnON: hihWd6dmtNIhemNeh$tN$CMVa WMIwryaMarnnateydero6WabwebylMprofersmppm8neme.iM-Ciasstfled.P-&-W <br /> maned aN labeladpbrmdad.and are n W mPerls b PrePxowdiM Iw aansPon aawdhg b appfxabb mlema0onal end nadoni govamrenld regdabwe.II export sNpreN and I an the Prvrury <br /> Expwter,I c dq Nat Ne rocans d Ors conpgrvneN mnlwm b the rims rime a.EPIAcknowlWyrrem d Ganem. <br /> Ion"Natth waste.,Nmraa..sblertreni aiwMed In 40 CFR 26217(a)(61 m a lege awlapty grremro)w(b)(0 I em a and Marbly gamosor)Is am. <br /> o eWs dol ypad NarreY <br /> � - c^`t <br /> s- Year <br /> 16.NlemaborW SNprreNa <br /> 1 H ❑hnpod b U.S. ❑ExPW hwn U.S. Pwl d entry/exit <br /> rcTraps ra nabre fore onl b lea': OaU.S.: <br /> I • ✓r' yd���v��/ W 17.Tra 5pP AdmmledgmWld RwWofMakmis ear <br /> V T <br /> ydT. TriNpwli2PnualfrypWName War <br /> IS Dscxmapq <br /> 16a.Dbortunry Indis b,Some ❑Damaly ❑Type ❑Residue ❑penutpurter. ❑Fu',i Rele.:pr <br /> M-leslRde—Number <br /> -- 16b.Aibmate Faolny(w Gent mar) U.S.EPA to Wrtlber <br /> LL FaCll sPNne: <br /> t¢x�j 1. nabxa OfNWNk FaoNy(a G.—I.) Mawr Day Your <br /> �~2 <br /> 19.Nezardaus Y7 isle RepartNmagmrem Me"Codes(e.Codesewharearous waste Ind—dsPosd.aN—Org Rsa pwl <br /> 11. 2. _ s -y6. d. <br /> 1 hereby authorize the repair work to be done along with the necessary material,and hereby grant you sod/or your employees•permission Ip operate the vehicle herein described 20.Disagnolad Facility OwnwwOperabr.C.O.Wralreceipipf hawdous antarials covered by the miaei except as tmted in nem l6a <br /> on the streew,highways or deewhem for the purpose of testing and/or inspection.An express mechanic's lien is hereby acknowledged on above v,Wcic to secure the amount PN ymd Na r neMa Monty Oay Yei <br /> of repairs thereto.You will tire be held responsible for loss or damage Io rhe vehicle or articles left in We vehicle in case,or fire.Neff.accident or my other cause beyond your conuul. r �. �y %. 7 :� <br /> Thank You for your business. Retorque lug nuts after 50 miles. ---� <br /> By signing below,NWm <br /> e cuser agrees to NW e semce be performnon Tire <br /> ed.Branis not respm responsible for my item left in the vehicle.Any changes rhe estmied charges will be <br /> approved before my work is done.Braman Tire will charge a lam fee of 112%per month up W a[oral of 18%per year on all invoices-1 paid by the corms on she invoice. <br />