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4ec-03-08 13:37 From-N Dixr 17076782339 T-445 P 003/009 F-886 <br /> Pbase print or tm,(Form desl nod for uao on elite 12Tftch)"wftrl Folin Approvod.OMB NO.2050-0038 <br /> 1.Gerwator It] Umber 2.Pepe 1 of 3.EmapencY Rsepmee Phone n Im rN1 Number <br /> UNIFORM HAZARDOUS , .1004537301 tJJ K <br /> WASTE MANIFEST C A p 2 8 2 7 7 0 3 6 <br /> 5.Gattaetere Nuns and MMWV Addreee a She Addraa(e ditrent thin maiYnO addraea) <br /> ASBURY EWRf�NT SERVICES- <br /> QDD S.ON YA FE AVEcowTCA 9W I <br /> Gerroratoeo Rasa: U,S.ERI ID Number <br /> e.Tlsnaporler 1 Comp8ny Name <br /> • CA p 0 28277036 <br /> U.S.EP+k ID Number <br /> 7.Ttansporta'2 CornpenY <br /> 8,DmV mwd Fwwty Nems end SbAddrep U.S.EP.110 Number <br /> DK QDM <br /> DMON ON WAY Ch ' <br /> C P► T 0 9 0 0 1 Z S O x <br /> Fall ■Pltorte: OMMAM <br /> Bb.us,DoT Deaal{Abn(IncludkV Proper s"Name,Ftaard Clea,ID Number, No CCnteinan Ou Totef 12.Unit 13.Vyeritr Coda <br /> Mand Pacldrq Group Ram)) No, Type Qt++n�V NMlol. <br /> 2121 <br /> NqN-RCRA KAZ*D0Us ASTE, LIQUID(USED OIL!IMYED OIL) 001 TT L �� <br /> 2. <br /> 3. pit(Dixon has the appropriate Pemilts 10 <br /> receive your waSte,Jand has recely 6 2e <br /> ,. <br /> 1 InetNdlena and I ( , <br /> NkR(W 991 : M v PR LE*9B I : USED OIL!MIXED OILS'APPROPRIATE PERSONAL PROTI: dUIP111ENT <br /> 15, OENEMTOR'afoFf6Rt71t'a GERTIFlUr0 N: I hereby dada°that ate oo*Vb of"=Mvinent tee k*srtd IMMO lY dse x#W above by ri+.pn,per ehit>pin0 wne,and w GeeelM1ad,asckapad, <br /> marlmd and Ishd.doscarded,and aro In so reap"In pvw oonom for nnepat aoaordktp b vl*1 bis InMmaww arta naaonal gv"v isntal MW&UOW h tip on YYprnent snd I sm ON Pdrrwy <br /> r I oedlfy 7prt the oortterne of this coneipnment conform m dte tamer aft alladted EPA Adotorrtedprtmrd of Canard. <br /> EAVWII cahfy to ft wnw dnin i"s swwpent IdendW In AO CFR 262 21(°)Ch I am a farpe gttarr0ty penerahx)or(b)(XI atl a°map QuardNy pttteratal fs . <br /> Genera Privmoo -Dw—yur <br /> n� L (0 1� 1 D S 21 ow <br /> � I <br /> 10.Interne pests Q Import b U.S. Q Export bam U.S. Part of emrytmd <br /> T(Anspu�el vwre(for egorts ). Date teavkl0 U.S.: <br /> 17,ft"mW AdugY Mgff OM of RDCW d Materlale s Yw <br /> TTWWJJ1 d 06 <br /> 2 S�> ro Month Day Yah <br /> 10.DhtaspawY I�-1 <br /> 16a.Dfenspsncy IrxA Am Specs ❑Type ❑Redd. iJ Pau Re0eW, �Full X14^ <br /> f bnftd Rakrwm Number <br /> U.S.EPA IDPH ID Numdw <br /> 5 job.Atbmate Fadldy la Garerabr) <br /> � <br /> Fedllty a Pfrane: MaMh Day Yw <br /> F 16e, nabs° te IfY(or nerarorl <br /> 19KmAWA VVaste Repos Manspement Mead Codes[i.e.,Mae for h—rdam.ade treeanem,*POI 1,and reayding systems) _ <br /> 1. HI q I <br /> 2. 3. 4. <br /> 20.DOAd Kdltty Owner or operautr CertfAoeaon of receipt d f1B28r,oue matartde oovaad by dye medleet except ea need In Item 188 ear <br /> ams � salter° <br /> FACILITY TQ GENERATOR <br /> Form 0700-22(Rev.3-05) FIVAOUs BOWS are Obsolete. pE51a'NATED <br />