Laserfiche WebLink
Please prinl or type.(Form designed for use on elite jig-ltclr)lypehvriter•) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator 9)Number 2.Page 1 of 3.Emergency Response Phone r016869779 <br /> Manifest Tracking Number <br /> WASTPMANIFEST CAD981967680 1 80Q 424-9300 JJK <br /> 5 OennratorsNimeandNaitinuAtnLass Gonerator•sSilo Address(if different than mailing.address) <br /> STOCKTON DODGE INC <br /> d 3333 AUTO CENTER CIRCLE <br /> STOCKTON CA 95212 <br /> Generatoe.s,Phone: 209 477-3665 <br /> 6.Transpnrler 1 Company N'irrw U.5-EPA 10 Number f <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> _.............. <br /> �.. ._.. <br /> 7.Transpalor 2 Canpnny Name U.S.EPA 10 Number <br /> 5,Designalod Facliity I'larne and Sile Address U S.EPA ID Numbar <br /> US-ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES -• CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Fndlfiy's Phone: T _ <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tolal 12.Unit <br /> 13.Waste Codes <br /> HM <br /> and Packing Group[if any)) No. Typo Quantity WtNol. <br /> 1' UN1991 WASTE FLAMMABLE WASTE LIQUID, N.O.S.,(DIESEL. D0 D018 343 <br /> GASOLINE),3,PG'III D A I S:S G <br /> CD <br /> a. Y <br /> 14.Spedy Handling Instructions and Additional InImmallon <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4.24-9300 *}PVOFILE#9131:051817-04 QIEPEL,GASOfJNE*P500-00032998 <br /> APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT {-F] �,'�^7 f I 51 5 <br /> 15, GENERATOR'SIOFFEROR'S LEKnFIWION:I tmrelry dedore thni the conienis of ols tomignmrent tea kAy and accuralely described above by the ptapereNpping name,and are eLyfAcd,packagorl, <br /> marked and lnbdedlptac rded,end are.in all respects In pro"ccndiiion for transport aoiWding to appllcablo inlamationol and nallonat governmental regwafidns.I(expo shipment and 1 am the Pr maty <br /> Exporter,I cD ft that the laments of this cgn:lgr lwt conferm to the temps of tho attached EPAAckrrowledgmant of Consanb <br /> I.car*Mal the waste minnnlxafion stnrement Idenliifled h 40 CFR 262-27(a)Cir lam a Foga gwmbly generator}or @) a small qu. dfy gme bl r <br /> pommot'stOOerors Pdraedrr red Name Sig Month Day Year <br /> 18.Inutmatl rrW Shipments ' <br /> F. ❑Import to U.S. ❑Export from U.S. Pott of entrylexib <br /> z Transporter signature(for exports only): Date leaving U.S- <br /> LW 17.Transporter Acknowledgment of Receipt of Materials <br /> TranWor t Pnnt yped arae Slennlura Month Uly� ')Iew <br /> z Tra nrzxrtif 2 Pra'iyTy4jodNoma Signature Month Day Year <br /> Q <br /> r— <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Ouanfily El Type ❑Residue ❑Padtal Rejection ❑Full Rejection <br /> Mani feslReferenee Nunhbc•r, <br /> 18b,Alternate Facklly for Generator) U.S.EPA ID Number <br /> V <br /> LL acility's Phone: <br /> w 1 rf c.Siguatera o1 AAema:a Faculy(m Genemtar) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 1 3. 4, <br /> 20.Designated Facillty Owner or Operator.Crst18ratlan of receipt.6Ehazardous materials covered by the manifest except as noted in Item 183 <br /> Printed/Typed Name Signature I Month I Day Year <br /> 1 L <br /> EPA Form 870O-22(Rev.3-05) Previw3 editJons are absolute. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />