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Please print of We.(Form designed for use on 011ie(12pitch) 'er.) Form Approved.OM8 No.2050-0030 <br /> UNIFORM HAZARDOUS 1.cemrota WNumwr 2.Page ldl 3.Fmesgenry Response Ptmne 0.Ma lest Lachlnp umber <br /> WASTE MANIFEST OA L000269375 1' (800)424-9300 015140.015 JJK <br /> 5.Ueremeoys Mae andMaO'rgAddrsss Ge etAl rsabMdress(if diferem Dan ma_ngaddress) <br /> PICK N PULL 080 <br /> 3927 CLARK OR 3927 CLARK DR <br /> STOCKTON CA 95205 STOCKTON CA 95205 <br /> Gwraws rbons: 910 689-2000 <br /> 6.Larawer I Cwnpany Name U.S.EPAID Numbes <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 '.. <br /> 7.rremporlerx campaAr Name U.S.EPA1D Number <br /> B. <br /> DK Des!gnaledFame aM SleAd&ass U.SEPAIDNumbm <br /> DIXONXON <br /> 7300.CHEVRON WAY <br /> DIXON CA 95620 <br /> Fabt Aphaa: (707)6936008 CAT080012602 <br /> ea. M.U.S.DOT Description Pnotwm Now Slapping Name,Hazard Clms,ID Number, IO.Conla'nma Ui <br /> HAI aW PackkV Glous(daay)) No. Type Duano11.TOWl ty t 12 12.Ufl.uT 13.WastaCodes <br /> C I NON-RCNA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL) 001 T T G 221_. �_...... <br /> 3. <br /> I <br /> t i <br /> 1 <br /> Id.Spedal Nandsfg lmuatensawAddM1aalMbrlratidn 'i <br /> EMERGENCY CONTACT:CHEMTREC 1.800.424-9300 NAERGA 981:17 *P OF] 1:DK100184 T CKN_ <br /> ADDITI NAL EPA CODES:981:,NONE *APPROPRIATE PERSONAL PRO ECTI QUIPMENT <br /> 15. GENERA 'SIOFFEROR'SCERTIFI T :Iherebydedme0a ftoorg nls ofImscons' .larenAy rid. Ieydescn0ed abara bYU p rsh'ppegname,ardareda55fixd,pacGged, <br /> n az. fbe&d7pacmdM,ended r snprapar(sndwnfabampat W icabtelnl indt mrvral posxianeAml atore.IlespM SNpmed arxllamNe Primary <br /> -AE <br /> rkr,l e ' eWteatanmlad arta iwnbrmblha leets olUe aBathedE nofCore <br /> 0a merle mWnAzaron slat H/OCFRx6xx7(a)gltamalazgaW NOa creta) b)pfl tr)IEWO. <br /> Gem w slOpa s ypedMoOfth Day Year <br /> J iSlnemab'aW ms <br /> ` 2 <br /> 3/ 11 <br /> Nnpon m U.S. ❑ErpM from U.S. ofeldiyfes;t: <br /> Tmm7wWs!gnata (rer mpods oary): Dau rug U.S.: <br /> 17.TrenspanaAtknanrsdgne�ddRasplal hla'sdals <br /> o Tran a iZNa 7 Sgmwre NmnU DCL <br /> ay Year <br /> Off <br /> ran;gala Print ) arta Sig a M1 nU D Year <br /> i ,A.ascuyancy <br /> 16a.asrapamylw�wnsPaw ❑flrat ❑Typa ❑ftaoue ❑ParwiRajw;.n ❑FWRe'ecow. <br /> AUMosI Relereme 77umwr: <br /> Ieb.ANam's Fecslry(a Cwua'or) U.S.EPAID Number <br /> w Holly$Phone: <br /> w 18o SgnsbaoolAliewte FaoVy ImGenerator) h'.dnU Day Year _ <br /> 10.IieaeNwsWasbf ReporlManagemeAll,!eflodCodes p.e,cedes fort usdouswaste Watmerl,disposal,andsecyc4rg systems) <br /> p 1. 2. <br /> ?O.Des�nated FacSyOnrarorOpemlor:Ceri6awndrecefplofhaTesdwemateriaswmed by Pa madhslerwplas aledtieem lea <br /> PA" <br /> ype S'gnaw�J WwU-DayYo". <br /> EPA Form 8700.22(Rev.3-05kPre 'our edi8orss are obsdeie. <br /> DEQWATED kbl-TINJO DESTINATION STATE(IF REQUIRED) <br />