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Please print of type.(fam tles!gned for use on elite(12-p(ch)typewatec) Fonn Approved.011,18 No.20500039 <br /> UNIFORM IIAIAROOUS 1 Genemlor lD Number ?Page l of 3.Emergency Response Plana 4 Maoifeal Trackla9 Number j <br /> WASTE MANIFEOL° C A L O"0 0 2 13 9 3 7 5 1 (900)424-9300 01182724 <br /> . 4 JJ K. <br /> '.: 5.GenerelWsHeme am MaargAddress- Gederatu(s site Address(dSGerea thanmanrg address) <br /> PICK NPULL 480 <br /> X�29�27 CLARK DR 3927 CLARK DR <br /> CeawafoTsKTO,aN CA 95205 STOCKTON CA 95205 <br /> 817frrawer i Company Nwe - U.S.EPAIDN'miwer - - - <br /> ICA00292770313 <br /> 7,Danapoder2 Company FlaAe U.S.EPA ID Numb-, <br /> I <br /> h.Des'gnaled Far':Ty Name and Sae Address U.S.EPAIDNumber j <br /> DK DIXON <br /> 7300CHEYRON WAY <br /> F <br /> MON CA 95620 AT080012602 <br /> 9a 9b,U.S.COT Oescriptm(AdWrg Proper Sygpnp Name,HaurdPass,ID Num cr, 19.CenIaYWa <br /> U.T.Le 12Un1 <br /> H7.1 and Pacti^g Group(darty)) No. T1Pa QUmbry 'i+TNoE 13:55'asle Codes <br /> o INON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL) 00i T 1� G 221 <br /> w <br /> 3. <br /> 4. :..-:':' ' .: -tJ <br /> Id Special H3ddAv &exwnS1WAda1id oT.—W <br /> NAERQ# SIR 1:171* PROFILE N 981:DK100194 EMERGENCY CONTACT:CHEMTREC 1.900-424-9300* �. <br /> ADDITIONAL EPA CODES:9B1:,NONE*A P 0 R RTE PERSONAL PROTECTIVE EQUIPMENT <br /> 15...OENER4TOR510FFERUR'S CERTIFICATION:I haebydeclare juiftha C(Wiate;laO'scans!gnmenIw8#pyW acoundelydescriDMaboya hy9wproper sh-0p4eg name,ard_WdaWled,pactagud, <br /> mayuad and labe'odlpanrded,andare N al raspeosN popeycarkean kr uamDodattgdngaappCpblo�IernamnalendrafMWgoyerNnenW rapulaGons.tlespod sh'pmeM W l am dePlemary <br /> EipaNtlttrGPypulUe rgnlenLt ofNh eonsynmeMrm!ormbuu lama ufthoallarAed EPnAcknsukdgrneaaCumen I <br /> Icera(yNal Nassasla ida'mrineonsla:email keneaedin 40 CFR IBt plla)(dl amalargo quall4TygeAeraNr)a(h)Qllama ub''lygene2bON <br /> GemreSey?�Omfoy ypaQName Rnetae wrap Day '1eaz <br /> J TB.NderrlaEMaSapmenla-: l <br /> ❑Lupo{NUS ❑FyppdUegl Pwideary,'enl <br /> Tnnapaler sl9naNrelraeaPuk aH/), Da lean'5US.: ,- <br /> IZTrerkp6rler dedgmeaa hYteas <br /> T SMdName t:.onth Day Ye <br /> N4rca Sgw 'um, Day ear <br /> 18.Discapamy - <br /> n1a.D'screparryt0staUmSpam ❑CvanWy <br /> FdI Re,e[tis❑ ; <br /> !'an fest Reference!;umber: I <br /> 186.ANenrto7aa7y(orOemuNr) US EPAIDNumber <br /> J <br /> ua- Facnys Pima <br /> 180.Sgnalwo of Nlerwlo FAV ty(of GemramrJ tlonth Day: Yrar <br /> le.Haaarcbus Mile Report Manap toodlielnd Codes pd.,codes for hauedous wasla!realmend,disposal,and regikrgsyslenu) <br /> 3 4 <br /> 2p.Pessgnaled Fac&ty Oasar or OperaNr;Cerb'P,caE9rsarece'pl olNaurdms matedzls darared aJ lhamareieslexreDlas naedMltem l8e <br /> Pml ypedName wNre hath Day Year <br /> rubtif p <br /> EPpForm 8700-12(Rev.3•96)Provlousedi' .sore obsolete. DESIGNATED FACILI"TYTO DESTINATION STATE(IF REQUIRED) <br />