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Please Print or type.(Foran designed for use on oblo(11-pitch)typewrilec) FufniApproved.OMB No.2050,0039 <br /> UNIFORId NAZAR00US 1.GaeuaWtu Nunber 2.Page Iof 3.Emergency Response Phow 4.Manifest Tracking Nwnber <br /> WASTE 61ANIFEST L 7 7 5 1 (800)4..4-e300 011827263 JJ K <br /> 5.Gemvow stime and fivigAderess Deneraw's WAddress(A Mateol bun ma¢rig address) <br /> PICK N PULL Nt30 <br /> 3927 CLARK OR 3927 CLARK OR <br /> STOCKTON CA 95206 STOCKTON cat 99203 <br /> GeRmloespk".. amo s iG . ^000 <br /> 6.Tmropwlw l CempanyN <br /> U.S.EPAID Number '. <br /> B F N ENTAI-SERVICES A 0029 7'703G <br /> 7.Dampoder7 CompanyName U.S.EPAID I,— <br /> S.Oesgreled Far5y NanwaneSibAddiess U.S.EPAID Monter <br /> OK DIXON <br /> 7300 CHEVRON WAY <br /> DIXON CA 95620 <br /> Fav (ilehoru: 170711393-13,000 I.AT080012602 <br /> 94. 9b.U.&GOT Des(riptuno"weg poop"shweg Name,IWzerd Class,1D bel, to.Conveners 11.row 12.UM <br /> Ntl an,11'"Groupelanr)) No. TYPO Guaney lzum de <br /> 13.%%!e Cos <br /> Vit NOL <br /> o 'NON-RCRA HATARDOUS WASTE.LIQUID(ETHYLENE GLYCOL 001 -T G 133 <br /> SOLUTIONS) <br /> w <br /> Wit z. <br /> A <br /> I <br /> 4. <br /> i <br /> I I <br /> 14.Spttial Hard9g Imbtusons antlA4e[mnal IrdemwCws <br /> NAERGN 981:171+'PROFILE#98i:DKi00i83**^EMERGENC:YCONTACT:CHEMTREC:LA00-424-3.300'' <br /> ADDITIONAL EPA CODES:961:,NONE s APP /I� RSONAL PROTECTIVE EQUIPMENT <br /> J <br /> 16. GENERATOR'SIGFFEROR'SCER71FlCAlIOt1:Iherebydedare WlTacantenlsofM:sconssgwnenl aro fv'yand awurekydescnbed above byuaptotet Aiypngnama.ardareclass:fea.packaged. <br /> marked and Ube'edryacarded,end ae in edrespects in proper cond.Eon for benspwt"amog beep!ab!o WemaGonalad na'anal governmental reOWal'ons.II wponsNpmenland I amlha Poway <br /> Espoder,I cedy Tal Use contents of thla cons'gnmemren'Ams to the terms of the attached EPA7ukreMsogreent of Consent <br /> I certify Tatthe waste efn'mkaton safementidenofed in 40 CFA 262.27(a)(II am a large quantity generalm)w(b)(dl wilJolalbTantlygwcera bue. <br /> Generaw/rr_0 ePdnNd7fypedJlah6) 3'gnabxe G 1.!eMh Day Year i <br /> I6.IMernaCaruJ Shipments <br /> z ❑Impwl .S. ❑Espen gem . . Dpart ofate <br /> My,'ea <br /> Transporter s:gnalure((a eYpods oNyg Dale kar'n9 U.S.: I <br /> w 77.LenspxkrAekrwn! mxnlal Rere'pl ofhlaww's <br /> 7 r t IPed Name S�gnahuo <br /> R <br /> - Month Day Year f <br /> < iranspodw 2 Piinled)Yypatl Name 3'gnatwe <br /> A:mtA My Yea, <br /> {. IS dauepanry <br /> INa.D;scmpamy lMzat'on Space ❑only ❑TYpa ❑Rea'due ❑ParHfReecl'on ❑Fe'IReY<lion <br /> f.6nifesl Refae---#amber. <br /> 16b.Nlemato FacAy(wGenerawl U.S.EPAID Number i <br /> U <br /> rQa- Fad':ty'sPhwe, <br /> 18c.SymtwaelN(anah FarFlry(orGenere!oq 1.WmA Day Year <br /> s(D I9.lfa:anbus Waste RepWlblaoagementuagneoCadet pe,Mae krhaaordous waste beattem,&spoeakondmc)Thn93y9ems) <br /> {hl{ <br /> 20.Desrgoaled Facf1y04w of 0petatw:Catikat'on drewglof harardous makrfa!s covered bytha manitesteccept as rded in Rem th <br /> foft"/TyFed Name S!gnawre I.anT Oay Year <br /> ,r� <br /> EPA Foam 8700-22(NI,7.05) PrevioU editions am obsolete. 0ESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />