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• 0 <br /> Plea se Pdnl or type,(Form des:fled toruse on elite(12•pilch)typewriter.) FdrmApproved.0818 No.2050*39 <br /> UNIFORM HAZARDOUS I•GeneralctrlDRumber 2.Pagelol 3.Emezgency Response Phone .MeaneslLacWg Number <br /> WASTE MANIFEST C A L 0 0 0 2 6 9 3 7 5 1 (800)424.9300 012426130 JJ K LI, <br /> 3.GeneraW$Nameand MaNAddrass GeoerMNs S.Waldress[ddNe(enp Nan mafng address) <br /> PICK N PULL 480 <br /> 2827 CLARK DR 3927 CLARK DR <br /> STOCKTON CA 95205 STOCKTON CA 95205 <br /> Genora106 Phone: 9 <br /> d -lg 009-2000 <br /> ➢amporef I Canpany Namo <br /> U,3.EPAID Number <br /> Y NV)RONMENTAL SERVICES A D 0 29277036 <br /> 7.lumport•r2 CorcganVsame <br /> U.S.FPAID Number , <br /> S.Dedynated FaC4d Name and Sae Address- U.S.EPAIDNumber <br /> DK DIXON <br /> 7300 CHEVRON WAY <br /> DIXON CA 95620 <br /> FwWl s Phan•: (707)693.6006 PATO8OOi26O2 <br /> 9, 9D.U.S.DOT Descown liidudag Proper SbpprgName.Retard Cus,IONumber, 10.Comainers 11.T0W 12.Ua1 <br /> HM andpad"Gmup(damfH 13.5Yasle Codas <br /> No. type QianOry, PIDYol. <br /> r 'NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL 0 01 rT G 133 <br /> SOLUTIONS) 2 D <br /> m <br /> J I <br /> �u 2, <br /> a j I <br /> l <br /> n. <br /> I <br /> I/.Spedal Hano!:Ig MSWcI'0m andAtldn:aW Informafon ' <br /> NAERG# 9Bi:171* PROFILE#981:DKi00183***EMERGENCY CONTACT:CHEMTREC i-8005249300 er <br /> ADDITIONAL EPA CODES:981:.NONE*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> T6. 0EtlERAT0R'810FFER0R'S CERTIFICATION;I herebydedae Uat Ne omenta olNds tons'gnmamarelu7yandavuralNydasa#d share Oy Ne gopar shyp�iig nam•,and arefbSsiFed.pacfeged, <br /> mExapfoaertdera,iId0h8b1ey!ethatdarpl the condk,mansdoal NesIntao?sresnpmn l p=k(mlo•frha le mtosoelamo pOattachedfcheed EpAAfoC",Teig mkaIolcdenl.nalbnm gavemmenWregulaCom.Nezpal shymenlud Iam No Pdmary <br /> I caiG(yN1a1N wade mr'rrvaaaan ahlemenl Mengfied Nd0 Cf R26227(a)[dpamalarge WaNilygaK+a'a)a(b((dla sma9 geanGN9enerela)is lne. <br /> C a P d Sgmbrr Month Day Year <br /> 1 12V <br /> —s tS.lnte al 'yt <br /> 1mpM to U.S. ❑Exp0d0an U.S <br /> U <br /> Tmmpalergnabre(brepalsontyl: Date W)dvU.S.: <br /> G' 17.1m nmenlom to(Mafedah <br /> Ts 'nledr7yped'mName S nabs• <br /> O MonthDay les, <br /> N d t <br /> Tran . 2 rto yped Name 0.ve h!Onm Us Too, <br /> {. I8.D'sfrepaay <br /> 189.Vsaepancy hdpyon Space Quantity ❑Type ❑ReWue ❑perm e(ecka El TO R.,ulson <br /> MWalRelerence Number. <br /> 18b.ANesrute Wry(or Generator) U.S.EPA 10 Number <br /> U <br /> rQ FaWnys Phone: <br /> a 18c.Spmbxv olArlerm(o FaN4(a Generator) ManN Day Year <br /> Z <br /> pIg.Hazardous Waste Report Management Method codes(e.,codes for hazardous wastebestmenl disposal,and regCSng systems) <br /> 1 I 2. 9. d. <br /> 20.Des'gnakd FeO"RyOxnera0paala:CaAfealronolrec•!pldhazasd0usmaladahcazeredWNerrerilmlaa snood In Item 18a <br /> m1eM oma r— 3,g•abxe < Month Day Year <br /> QlGt +a- 10/1Z / <br /> EPA Form 8700.22(Reu3.05)Pteviouseditions are obsdele. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />