Laserfiche WebLink
� s <br />Please ednt or toe. (Form deelnmM <br />UM0[UWAltU FACILITYTO DESTINATION STATE OF REQUIRED) <br />. _....._. ..ram oveaane ND 106U:OWB <br />UNIFORM HAZAR0003 1. GeneraWwNan6ar. - - 2. Page f of lcmegmftosga Plena WnllmlT a erWASTE <br />MANIFEST . A R 0 0 0 2 0 9 0 7 s 009514415 JJK <br />a. GanamlWaxaro ear rdaRrettdresa fdGwg eMmelrmsRpWdrp)_.. <br />PICK N PULL #10 <br />76M STOCKTON BLVD j®08 gTp� g�Vp , <br />w SawGPRmnNeEN70 VARR OA.. ,.OA <br />pnspprler,t Cotpary Nmne <br />- -... 7 ! $ .ai <br />Fai�NameardSkeAddrass - - - ...., <br />., .IXON <br />CHEVRON WAYN <br />QA 85620a: <br />A B 0.0 1 2 6 0 3.S.00TDewipAoa(aMr9rgPrgd9ldpping <br />Name, Herad Class,wxumbr,".. <br />14 (LrIY6en <br />iL 7oW <br />12Uegadang <br />kwP(danY)) <br />mm <br />;Oond1• <br />RCRAHAZARDOUS WASTE, LIUQID (USED.QILlMXEQOIIJ <br />r1AVjmkm9WAdd%" <br />TG <br />� Indamkm 9W InMmeeon <br />NAERD# 081: 171 ' PROFILE #981: DK100232 TIVEROENCY CONTACT: CHEIWREC I -804424-M 2 ADOITIONAL EPA <br />CODES: g81: , NONE `APPROPRIATE PERSONAL P,ROTECTIVE£QUIPNENT <br />15. OENERATOR'S/OFFEROR'S CER9FICATIOH: I ha td"m that he wnmbol %bogvUrrrxrase /u/ysigaawatelydeev6edabms by Mpopers84Vh8 mme ardwo dsesded, pads*, <br />madted sad beebdMiawrdad, andare h Mreepecta h pmpaeondigon krSemPedrmrdYg bapplrade NWwfwWand neeorW gosemmablregulmbas. Me ryat sxgrgflaMlam Ne PdmrY <br />Expede6l cu6fy gal Ne mnlenbal NbanvlevrearepYorm hltg rampurlhe atWahed EPAAdugM1ledgugpto1Ca15ent <br />I epllfyWtUrewasre ninlidxeNmaratamen(Wanldedh 40CFR 282,27(e)(glem ermgequm�9anerab) @) Isrrrasrnee r*0Wtt*m)bwe. <br />Oenwala1/OMaots PdnledR)yed <br />�1' <br />J 8. Memetbnst8hpu�enb 05 <br />❑ <br />YrpeA,bUs. Epm"a s. PedereMgdwt_ <br />Trenspaler s8rroexe(fa export adi]: Dale leaving U.S.: <br />. <br />17, TranrporWAdv w"oleaof Rec*of MAW* <br />TranapMnr 7 Pkdarytylpd a - axe <br />MaaO - lter. <br />d <br />e <br />r. _..., P �: s O <br />renspoder2 edRyped emeeire MwA, Da)' Ywf <br />}. <br />18. gsoerwwwy <br />I <br />r'� rr�� <br />I"owrep;ry 4doawS•je ❑QuarYRY UTm IJReedw ❑Pm9al Re{xtlon ❑FNR*,§. <br />MeiNas(fte7erence tVnnSer. <br />18A Hamate Fadiy(a0enerero0 <br />U.S. EPAIDNueper <br />Faaw, phone: <br />IBa signaturebFariry(a OswreW) <br />Day ear <br />12. <br />Nezmdma Waste ftepod MumvirenrPkUWCodes Am, modes Axhnardpwnaereuwlnwµ Asposal, end tg roq srsleme) <br />c i, <br />2. 3. 4. <br />ul <br />1 20. Destmied FaaRy O.m w0p.,aW.Cer.Z*(reedpraha:ardewmduWe;"by0eumgeda ap as wed In Mem r8a <br />W e <br />1_ Nr. <br />EPAForm 8700.221 ev.305 Prnvla�a Mi Ims am nhwam <br />UM0[UWAltU FACILITYTO DESTINATION STATE OF REQUIRED) <br />