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Please print of e.(Form doskp,ed for use an alto 02-Pilch) pemriler.) FamApproved.018 No.20504M <br /> UNIFOR7ANAZARDOUS I.Generalorro Number 1.Paga fol 3.Emergencyl2w(rnse Piwre 4.Manifasl Tucking umber <br /> WASTE MANIFEST 1 800 424-9300 011827241 JJK <br /> 5.Generebrs Name and lAaragAddross Generalols SIeAdMess(ddaerenlNan mafngatldross) <br /> PICK N PULL#80 <br /> 3927 CLARK DR 3027 CLARK OR <br /> STOCKTON CA 95205 STOCKTON CA 95205 <br /> Generatots Phone: gA C 069-2000 <br /> lans _ <br /> opal riCampany l7m Us.EPAIDNu r <br /> 7.TranspoM1er2CompanyNama D <br /> 02927703fi <br /> LLS.EPAID Number i <br /> I <br /> 8.Desynated Fao,!y Nam.aWsito rWdcoss <br /> D&EPA ID Numhor j <br /> DK DIXON <br /> 7300 CHEVRON WAY j <br /> DIXON CA 96020 <br /> FaaA spiwne: A T 0 9 0 0 i 2 6 0 2 <br /> 9, 9b.U.S.001 Descdpton(Wodng proper sh$p mans,Heard Cia s,ID Number. 10.COnarnela ll,k'al 12.Una <br /> yp,{ ardPackirg Gaup grairy]) No Typo Ouamlty YlbVnL 13.Y7asla Caries <br /> L <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED 011./MIXED OIL) 001 T 0 221 <br /> z 2. <br /> a <br /> IN <br /> 4. <br /> fa.Spedal Real ing,mli m and AddFonal lntamaron <br /> NAERG# 981:171* PROFILE#9Bi:DK•100184 EMERGENCY CONTACT:CHEMTREC 1-800424-9300 <br /> ADDITIONAL EPA CODES:9Bi:,NONE*APPR(Z �)PyTR pP NAL PROTECTIVE EQUIPMENT <br /> I5. GEIIERATOR'SIOFFEROR'SCERTIFICATiOU:I rivalry declare that the a'on'.entsso�f(N90wns'gsmen(are(u7y and accumleydeunbed abo:a by the proper sh'pp'ngmme.and are dauirxd.packaged. I' <br /> marked am laWedlp'zcarA d.and are in all fall in proper conation for tramped acwding toawcatremwwti)Oalatd naranal governmental regulators.If espad Ui'Rmenlano IN,"Primary <br /> Espoder•IceKly Nal be conenls of INS cens!ganenl conform b Om termsof Ne eMOWd EPAAcknoe'.edgmerkofemn ent <br /> IcediFyUal tiwaasle m'n'm%rzt'mslatemenlidenufiedin 40CFR 292 P(a)(Jlamatarge quantirygenwata)a(E](ill oma mil t o, <br /> Oeixmlofsl0(k nledrf• war" : me <br /> TPa ✓ / A!ongs Da <br /> S9na Year <br /> E.S IS.Mtemam lW";.ma <br /> C2 ❑import toU.& ❑Expod from U. Ponor"dry-euc _ <br /> Transpoder srpirurroger export,ady): Dale ieavasp U.S.: ' <br /> 17.TranspoderPtknoe! alolfte"albla' <br /> Tuns . .d ypeO Name Sgnalure b'n0 DayYear <br /> 0- D a <br /> Z Trans Pr y d Name svedure ka JUMP, Day Yeas <br /> f5 <br /> } ,S.ftrepanty . <br /> Its,D'unepamy W(abon Space <br /> ❑Ouamih' ❑Type ❑ftas'doa ❑ParbalRaectbn ❑fW Re"eU'm <br /> 196.AIktnata Fm klarifesl Refaexe Number. <br /> sorry rNm ra:ar) U.S.EPAIO Number <br /> aFeaNVsKemar <br /> 0 1 <br /> vonatme Of anmc«I <br /> Q k!onlb Day year <br /> UsUs <br /> 19,11318Mous y','aste Report AbnagementMldwdCodes(i.e..codes for hamdousxasbtreatment dnpasaL and segoliM3yslems) <br /> o L 2. 3. 4 <br /> 2D.Desyreted Fa q*,,mwor Operator:CereEcaron olse 'lollwardousewevialscerered by the manifast earepl as Wed in W.m lga <br /> prcaedlpypad Name Sl ,� <br /> 9 N Day Yeas <br /> EPA form87!M-22(Iier.3-05) Praviousediliansare obsalelo. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />