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Piesse print or type.(Form designed for use on eXle(12-pilch)typeadler.) FormAppmved.01;13 No,2050-0039 <br /> UNIFORM HAZARDOUS 1.CenenlalDNumhes 2Page tot 7.EmalgmcyResponse PROM 4.Manilas)Trasking)umber <br /> WASTE MANIFEST C 0 0 2 6 9 3 7 5 i 800 4249300 011827265 JJ K <br /> ACtpneroWTpNamaandFWalgAddmss GamzaWSSdo Address(d+FRdeMGpamBggzddiess) <br /> plclt N PULL480 <br /> 40i'CLARKDR 3927 CLARK DR i ; <br /> StOGRTON CA 95205 STOCKTON CA 95205 s <br /> Generelols Phone: 916 GG9�2000 - I <br /> B.awlspoder l CempanyName US.EPAW Number <br /> YIRO ENT L SERVICES A D '8 2 7 7 0 3 9 <br /> 7.7renspMer2CampanyName UG.E <br /> Number <br /> B.Des'gm(ed FacFiN Nameand SfeAddress U.SEPAIDNumber <br /> DK DIXON <br /> I <br /> ONEYRON WAY <br /> DIXON CA 96820 <br /> FoaWi MnM: Ar08.0012G02 <br /> go. 96.US.DOTDoV*jon(ndudng fyapm5hpp'ip Name,.HwNpass,bNanber, 10.Conla'rrers 1i•Tolel 12.Vel 13.YJaYS Codes. <br /> H7d and PxHngcmup(darryq No. Type coambN WINN. <br /> o ANON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL 0 0 i T � G i33 <br /> 4 SOLUTIONS) <br /> b 2 <br /> 0 <br /> 1 <br /> . ..... 1 i <br /> 4. 'I <br /> I <br /> i <br /> 4pa WWdIOMaMAddSNulflda _..: <br /> NAERG# 991-IW 171.* PROFILE#9Bi:OK100183'"EMERGENCY CONTACT:CHEMTREC 1.8004249300 <br /> ADDITIONAL EPA CODES:9Bi:,NONE*,.A P 1 ERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'9fOFFEROR'SCERTIFICATION:I herebydadvas Ual Yabeansignmenl arefuyaM aftwa*daunYed atom by dsopropec sh!pprg moro,mdamdemWpadagal. <br /> rmdeedaMlabetedlplzoardeJ,artl ara lna9respacasMploperaMa.Msfq flemPPdapwsdalglgapp=aNe NI¢maEMalmM rutgnalgovermpnhlteyuhE'oru.IleapglalipMdarlQ_IamNrPOrMry . <br /> ;Eaypdau l rcrtH Nat ew tantents of IhisOuuignnlee!OaM,amb gre lermaoltlga8adud EPAAOWwnfedgeknlolCorssanL <br /> IwiNgsaidro»xsle ninhrJzalpssla'xmxNMen6fied in d0 Cfft20227(eI(alaniaWgegmnSlygeMratal of tb)(dl:masmalgaanSNgakratp)ft NN. - ' <br /> cengraWNDlhrahRlnteM(ypedName sfgnawfe .Z pr I <br /> —s A enLe.'. ❑ foUS <br /> ImDNt ❑ErOpARpa1.U.S. PoAal enlD•enL i <br /> ironspoAu sgMlwa(for eapalsadyk Dale leawng U.S.: I <br /> IT.TratupOSler olRecaylo4 <br /> Tre 'ledf l�rm $paehue <br /> Flpngs Day <br /> y151, <br /> 'i�rrtr <br /> T Name <br /> Ir!anez Day <br /> r <br /> 19e gsaepalpylrl�ialionJpmos �Qd" ❑Type ❑Resdue ❑Padr9Re,.t.. ❑Fu1Re)e<5as <br /> s'anbsl Reference Number <br /> I80.ANrMNFaWy(acamubd '. US.EPAIUNumber <br /> LL Fao3lya%pM: ' <br /> ai9c.SlgpaNreal le Faq'AM(a Generakr) h'.onlh Day Year <br /> W 19.Ilazardaus Was4efle/nlSWagerronl LkgwdCoda(La.,codes k*hazardomwastebefla diispo6Aam,eq"sysldm) <br /> 20.DaslpyyedFarAtyOasavar DPerelor:CtlEEgtlaldrecelptol hazardous mala6ygowrW6y9Mawdbsluapla rdad6pm18a <br /> P. daa d� pn9a Day Year <br /> Ciof 7 <br /> EPAFam 87c0.2(RaY,y05)Previow adlYplaaroouadele. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />