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Plea se pdnl or rype,(Form desgnmd for useon ebla(72 pilch)(y vmler.) Fgmlyproved.OM1f0 No.20500039 <br /> U4{ ORM HAZARDOUS 1G eoeratarlOAumber 1.Page of 3Emagenty Response pnme 4.Manliest Laogny NUmbe! <br /> LVASTEMANIFEST.. IR001 424-9300 011827267 JJK <br /> B:SMMraW/a Name xM MaIN Address Gelmala's&toA4Gas3(ddiAerenl9un rw!ag addtau). <br /> AKIN PULL NRO ) ' <br /> 0027 CLARK DR 3927 CLARK DR <br /> SJS)OKTON ' CA 95205 STOCKTON CA 95205 <br /> Oe6xaWaPheno, - <br /> QTranspalerlfwnparcy.Narra - U.S.EPA IO Number ; <br /> ON EN AL SERVICES - AD028277036 <br /> 7,7ranspa(x2Canpany Nama U.S..EPA 10 Number j <br /> 8,Dorgaa19QFp('dly Hame and S4a A9Mess <br /> . ,,..... U.S.EPA 10 Number <br /> UK <br /> 730(iCHEVRON WAY <br /> F 0(bN CA 95820 AT060012602 <br /> 008 <br /> 9a. :9b.Uri D0TD6wlpt"(Mudng Proper ShWag Nam.Haaard Gass U)ft" fO.GoMauws il.JoW 12 Urv1 <br /> flRl :and PatSng Dronp(darty)) No. .Type QuanbN vllfvd -13.Wasta Ca'es <br /> o NON RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL 0 0 i T �7 C�/ G 133 <br /> SOLUTIONS) L OCl <br /> w 2. <br /> 4. <br /> 14 Wal llanPrg lmiKWionsaMNMiCpp11n1ormalon <br /> NAERGH 961:171° PROFILE#9B1:DK1001R3***EMERGENCY CONTACT:CHEMTREC 1-900424-9300 <br /> ADDITIONAL ESA CODES:661:,NONE* ROP TE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. 0FAEItATON'SrOFFEROR'9 CERDFICATION:(hereby der!are lNe s wra:pnmxdaia hk/erA atturakrydesrnbe0ahosre hyUre proper stipyng narrs,aMare clauified.packa9m1. r <br /> makedand labeleNpgwded,amara N ay.respects bnMMv Akn W WorMaee "toq*a*bllemaTwnaladrrefiorolgovenunedal rego!aLo.He'podshymeM andlam Na Plenary <br /> Eipddx,Iceddylhal lhecaaeobofWsmaalgnrtgnla0bra,to the temw of Naedxited EPAA orrafedgmenl ofCansenl. <br /> 7cCiyylhal9w xaslemutsrera9anstalemenl(deMeedM40 CFR 2b21T(a)Cdlamelxsgegtix6lygeiRnloVa(bl GllamxsmYgWnXyglriaala)hew. �- I j <br /> Gemrehes'offameo PMkNfypedName Fre Day• Yea i <br /> Lull Vag,4 v <br /> -s 18.NaxruubnalSNpMnla ❑Fipol(rsxV.$. YMaI 1 <br /> ElYnpxlloU.S. <br /> Tronfporjir4lpnaWra(brespodsasy4 IMlekasdip U.9: <br /> It.TlwpMxAknotMedgmeidalRwajdWNatedats <br /> K T y➢�N+ma Syne, Day Year <br /> i <br /> Ta SgwNr Alen Day Year <br /> 18:D&xepancY <br /> 182 D'spemmWOOD Spaze ❑ QuanN tYTa ❑Resldu ❑PaiaetsQFs6 Re(eao ' <br /> Maafesl Refxence Nura�er: <br /> 18b.Ntems'e Fadty for Gehewor) U.S.EPA IO Numbx <br /> LL FaOtYs Phare: <br /> ww 191-Signature ofinemala Fa<Ary(or Cenermu) Moth Day Year <br /> 2 <br /> w19,Hatawdom Waste Report AWwgament Meawd Codes va,codes fa hazardous vmte ueNrneelAvLod,andrecyftmlems) <br /> 0 1• 2 A 4. <br /> 29.Dulow dFao'AlyOaneraOPmW.Cx4EeaEon ofwevi offamdsusmaterratscmxM byftmefKalauwosrated N Item 18a <br /> Prnt ame N Cay Year <br /> EPA Form 870022(Rev.3.05) Prearicars ediW amobsalele. DESIGNATED FACILE .DESTINATION STATE(IF REQUIRED) <br />