Laserfiche WebLink
1 <br />Plea se print ort e. Form dell ned for use on elle 12• Itch typewriter, <br />F A d <br />UNIFORM gt. GenemlOr 5Rumbez <br />HAZARDOUS 2. Pagetol 3.EmergencyResponse Phone <br />I <br />oN. prove .OM8 No.2050003b <br />4. —Manifest Tracking Numher <br />WASTE MANIFEST C A L• 0 (1 0 2 6 9 3 7 5 800) d3�,-930b <br />6 p g 8 1 6 8 9 6 JJ K <br />5. Generator's Name and p,nf, Address Generator's oneAddfess(a owerent Man mailing address) <br />PICK N PULL AU�f0 DISM4NTI_ERS STOCKTON LLC <br />3927K�K DR <br />CA 95246 <br />Generator'a PMno. 249 462'1927 " <br />6.Transponert Comp anyName <br />U.S. EPA ID Number <br />ASBURY ENVIRONNENTAL SERVICES <br />CA D 0 2 0 2 7 7 0 3 6 <br />1. Transporter 2 Company Name <br />U.S.OAID Number <br />E. Designated Faclily Name and Site Address <br />ROADSERVICES <br />U.S. EPAID Number <br />1616 SOUTH RIVER <br />WEST SACRANENTO CA 96091 <br />C A D 0 41 4 0 0 3 5 5 6 <br />Facb/sPhone: (916)371-6747 <br />_ga, <br />9b. U.S. DOT Deacdprw Ordudkmg Proper Shwng Name, Hazard Class, IDNumber, <br />10. Conjem <br />11.Totsl <br />12. Ung <br />HIA <br />and Packing Gfeup(dany)) <br />Quantity <br />WINd. <br />13. Waste Codes <br />Na <br />Type <br />>: <br />,. <br />221 <br />NON-RORA HAMRDOUS WASTE, LIQUID (USED OIUMXED 011.) <br />00f <br />I_ <br />z <br />z <br />3. <br />I <br />' <br />14. Spedal Handfn9ln'wbons and Additional Information <br />NAEROM 9©1 : 17 ) "PROFILE 1$ 981: 1'10111 ENEROENCY CONTACT: CHEMTREG 8P-424,%(0 ."ADDITIONAL EPA CODES: <br />081 : , NONE • APPROPRIATE PERSONAL PROTECTIVE EQUIPNENT <br />16. GENERATOR'SIOFFEROR'SCERTIFICATION: Ihereby dads, lhm the coMents of this cons'gnment are fifty and 8=rstely descrSed above by the p(oper shipping name. Ord ere classified, packaged, <br />masked and Iabeledlplacarded, sad are In eg respeds N proper cmdilion fortranspon according to applicable Wernallonsland national gmrammenlal regulat(ons. If exponn—wipmenl and I em ft Primary <br />Exporter, <br />I lenity that the tontenti of thIs consignment conform la theterms of the attached F-PAAcknowledg of Consent <br />IrRmrythat 'be .Waste mlnlmlzaUwstatement IdenttiledIn40CFR 262.27(a)(ifIamalargequanctygarter )or(b)Ofl ammailquantitygenerator)Isfrud. <br />'a r' ofsloNelas P n dfryped Name .... g <br />A UI Day Year <br />z t�, htemadogal <br />Shrpmenls <br />�frans <br />Impodto U.S. ❑Exponffom U.S. Portofenhylastlt: <br />? der sr <br />Pe Aclkne ((or exports onh <br />17. Ttanspoler'AtlewMedgmenl <br />Date leafingU <br />elplufmatedaln <br />Re <br />Tronspoder <br />P ed No <br />r c <br />6SE' <br />TrBntpode-2 <br />' . Slgnamrb <br />% / Mn Day Year <br />�� <br />PrnledRypad No <br />y; <br />SgnaWre <br />Month Day Year <br />ncy <br />- <br />i <br />i �Rdkaga�Spaca ❑Quantity ❑ Type ❑Residue <br />❑Pert�al ❑Fu'I <br />7€'' <br />Re,ecllan ReRch'an <br />t <br />I toFaot 1.lanifesl Relemnce Number. <br />ry(a Generales) <br />U.S. EPAID Number - <br />�!peib Faality or Generator" <br />FAonlh -Oay Year <br />Management kleMd Cod"",., cbdds for hazer" %este treatment, disposal, and recycling systems) <br />3. <br />-Fes Opera* Cergficagon ofrecelptofimazardous materials covered bythem pt In items <br />" <br />gnaNre <br />-v`Wl6V - <br />Day Year <br />7Z{ <br />fBV(eus edlllnn• e.., _r,.:,_._ —1- <br />2 `" <br />3 <br />"""'"'°'°' /171 161 611 1l.IT'YTO�[1 NPIA�KSN SiA7r (IF REQUIRED) <br />