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0 0 <br /> Plerso print Of We.(Form designed for use on elle(12-pilch)Iypavrtiler. 2.Page '. <br /> Form Approved.OMS No.20500039 <br /> UNIFORhI1U12ARDOUS I,Gaearalw lDKWMer dEmelgengRespwse Pham 4. an oat Lacking Number <br /> WASTE 61ANIFEST CAL000269375 1 (800)424-9300 015144995 JJK <br /> PICK ICK N PULL N80 <br /> S.GeneNe mo and lraaiygAddress GanefewsS?aAddress(if6P,erentthen maaflg address) <br /> 3927 CLARK DR 3927 CLARK DR <br /> STOCKTON CA 95205 STOCKTON CA 96205 <br /> Generator's Phone: 916 689-2000 <br /> 0.Transporter 1 CompanyNama U.S.EPA 10 Number <br /> ASBURY ENVIRONMENTAL SERVICES CA028277036 <br /> 7.Lanspwkr2 CompanyName U.SD.EPAID Atimbel <br /> B.Oes�grtaled FaNdy NamoaM Silepddrass <br /> DK DIXON U.S.Ex Ilumher i <br /> 7300 CHEVRON WAY <br /> DIXON CA 95620 <br /> Full',V$Phono: (707)693-6008 CAT 0 8 0 012 6 0 2 <br /> 9a. b.U.S.DOT Oexdptbnynduany Proper Stipp gNrne,Nazard gass,lOA'umber• 10,Coola'ners <br /> H!4 am Parkhg Group(ilany)) 11.Trial 12.Ud1 'i <br /> 1. <br /> No. Type Ownbty MAW. IJ.l9aslo Cures i <br /> o NON•RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL) 0 01 T T G 221 <br /> w <br /> 4. <br /> w z. <br /> c� <br /> W.Sptt%a1HenWng Ins WctbnsaMMdPanal Mfarmm6rs <br /> EMERGENCY CONTACT:CHEMTREC 1.800.424.9300 NACRGN 981:171 *PROFILE N 9B1:DKS00184 EMERGENCY f <br /> CONTACT:CHEMTREC 1-800424-9300 TRUCK N_"ADDITIONAL EPA CO :9B1: NONE "APPROPRIATE PERSONAL <br /> PROTECTIVE E UIPMENT <br /> I6. GENERATOR'S/OFFEROA'S CERTIFICATI011:Iherebydecrare that lhe<oritenls Wlhg cons!9nmenlaro FRtyand W• dtxnbedabowre jtheproper 'pp'rg ware,ardarec.Us0ed,packaged, <br /> 12=4mark l.r.Ic 4'pracaned,and are in a9respeclsia Pf"scondition for banspon accordigto appka" rna ons rafbrrolgvxmmanbllegW s.Neapodshpmentandlamme Primary <br /> K .l caur MIN cmlBnls of this cens`g ,enconformtothaeuntsoltheadached EPA Nkrp 0Cw1 <br /> Ice ntl N ss slemn'm'vaEonstalemeM of In40CFR26221(a)(if lama brg fluml,ly nerap) f( (rile 'Iquanery ge .ala4u we. <br /> Ge(krabfs sr' P MedriypMName aNre - AtanO, /Dry Yeal <br /> InferroCmal Shap nls Jp • `7 <br /> z Import to DS. ❑Expod k.U.S. P olentry;e>d: <br /> — Transpodersgnameyor xp'n"ols): <br /> � 17.Ira Dalo ip U.S.: <br /> nspollw Afhrua:edpna,M W Rece'q of hla!eAah <br /> Trans; de(111 rintedR d Na <br /> o moovi Day Year <br /> N <br /> Is er'Pnn d/fyge Be L711 771 A� <br /> squnure h NO, Day Year <br /> 18.Discrepancy <br /> tea.D:aflepancy mAta00n Space ❑ Ouangly ❑ <br /> Ty➢e ❑ResNw ❑PaAalRc;cc[an ❑Fug Re(e(Eas <br /> I86.AYerrele Fa(x Mani,WtReferewa Number: <br /> y(wGe alarm) U.S.EPAIDAV Ae( <br /> U <br /> u F20ys Phone: <br /> a� f .S:wNfooiNtemale awlf(orG"Alw) A{wJr Oar' Year <br /> 2 <br /> 55 I9.Hazardous Waste Rapod NanaglmaAlMOW Codes lie.,(adas for hazardous vss'a treatment.disposal.and(eq%&V systems) <br /> g 4 <br /> �I�I <br /> 20.Dasgnled FaUryOaner wOpemsor.CerdEwFon of rawq olheea(d0us wledars coowfed by he marilesl except as now in Item lSa <br /> Pdntedriyped Nam <br /> 6I Isiure on 0ay Year <br /> vl (ASCe It l } <br /> EPA Foml12700.22(Rev.3.05) Previous ed'dbn are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REOUIRED) <br />