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• • <br /> Please Print or We.(Folm designed for use on ehW V-pdch)typewiter.) FofmAppmvod.OMB No.20500030 <br /> UNIFORMHAZARDOUS 1-Ceneml,ID Nunder 2.Pagatol S.Ermrgtntyflespanm Ph 4.AIanIesl Thaeking Num b, <br /> wasrE MANIFEST C L 0 0 0 2 6 9 3 7 5 L 900 424-9300 011827264 JJ K <br /> 5.GMerabm Name eM hlatngAddmss Gemra!ofsSi(eAddress(iidAferem Nan maengaddmss) <br /> PICK N PULL#80 <br /> 3927 CLARK OR 3527 CLARK OR <br /> SPWTON CA 95205 STOCKTON CA 95205 <br /> G <br /> ene s a' <br /> 0.Trampod,IC Pany Nama <br /> U.S.EPAID Number <br /> SERVICES036 <br /> 7.Transp,ler 2 Cwrpany Name U.S.EPADttun0er <br /> 8.Desilmled Fac�my Name mW She Address U.S.EPA 10 Number <br /> DK X <br /> 7300 CHEVRON WAY <br /> DIXON CA 95620 <br /> Faor.I aPh,m: 0 6 8 "AT000012602 <br /> ad. 9b US Proper Sh'ppra)Nama,HazaNClass,lO Nwnbee to.Cents rsIt.TOW 12.Uri1 <br /> NAI and Pa<khg Group(ii anp)) NO. Type Dummy YAANI. 13.YyasbCaxs <br /> a INON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL <br /> 00' <br /> T O G 133 f <br /> SOLUTIONS) <br /> w z <br /> I <br /> 4 <br /> i <br /> 14.SpecralH,irWng bsbucWnsand Adddbnal Informten I <br /> NAERGN 981:171 a PROFILE H 9Bi:DK100183 sx*EMERGENCY CONTACT:CHEMTREC 1-800-4249300 <br /> ADDITIONAL EPA CODES:901;.NONE°!�' ROPRI TE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'S(OFFEROKSCERTIFICATN1N:I herebydeclare that Ow cordws We cdasgnnMore hAtyaMMwNdtydeisrhed AM b7 du props sh!ppng namo,ani aro dassifed,pat>.apd. <br /> marked ami faba!edlpaearded,aM am In a9 respects In prom cond£on f,om4x toaclsvg h aW aWo lnlerwromand moaulgosmmrnenial regumCam.:l eapodsNfarmmand i am the Primary <br /> Exponent Milk ftf the comahs of Nh mnsynnremcmlMn to the hems of the attached EPAAcswoabdgment of Consent. <br /> I m6fythat the waste mn'myafp 311tenmmideMfedb40CF 26227(a)(,II am a Nage qua ttygenerelor),Ib)(it I am a sma'Iq Tygenernsw)is bm. i <br /> GenemmyY08,oys PdnledRyyt�d7/{,xn�p S!gremre Manth Oay Year <br /> IB.Imeml»mlShipnenlsI <br /> Z bywtbU.S. ❑ExpMfrom U.S. PM nbylMT: I <br /> — LMspwiersgnalare(fa expads orvl}. Dam Nar'ag U.S.: <br /> IT T mspolIvAckno kdgmeMMRecol oRWA <br /> Trard ime sped Name Sgnalwo f;.gMhy OaY /Year r <br /> Tram ler2 Pr IeMYped Naris SgreNra MUM Day Year <br /> .F I8,Wsempamy <br /> 18a.Dkempincy lM:mBonSpuO <br /> ❑ lhmm8y ❑Tyya ❑Residue ❑Partial Rejector ❑Ful Rejeuan <br /> A!am'!asl Ralererrca NumSer. <br /> IBb.AO,mm Faofy(a GMeretwj U.S.EPAID Number <br /> V <br /> rai FaoSlYs PhMe: <br /> w <br /> led S-VulweafAtkmab Fao(ty(or Geneiat,) h'onN Day Year <br /> Q <br /> Z <br /> 19.1fmmdou YI to a tan genceUMeNnl Codestis,codes forbaxardouswaste beam:enl,disposal,and recycvng system) <br /> 3. 4. <br /> 70.Oes!gnaled Facdty mreew Opesla rGEcaBonalrempl of sardous mleda's arzmdhy Ne manilMt exmqunae ' f8a <br /> PM edlfYPedSgna,ro � L'r� Day <br /> S <br /> EPAFurm8700.22(Rev.3.05)Ism V wetTNomsareWholete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />