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C Please P;la yDE(Form designed for use on elite(12-pitch)typewriter.) Fan Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1'of 3.Emergency Response Phone' Manifest Tracking Number WASTE MANIFES C AA 1 0 0 0 2 6 9 3 7 5 - '; (�44)4245300 1. 0-12411253 J J K 5.Generalofs Name and Mailing Address Gemmtofs Site Address(f different than mailing address) PICK N PULL 'xY7c0 3927 CLARK DR 3527 CLARK DR STOCKTOH CA 95205 STOCKTON CA 95205 Gener n Phone: 916 G99-2400 6.Transporter 1 Company Name U.S.EPA ID Number ASEURY ENVIRONMENTAL SERVES CAD 0 2 8 2 7 7 0 3 6 0 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number DK DIXON 7300 CHEVRON WAY DWON CA 55624 Fadiitya Phone: 7071693-6045 C�,T 0 6 4 0 i 2 6 0 2 ga Sb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Picking Group(f any)) No. Type Quantity W Wal. K NON—RC RA HA?ARDOUS WASTE,LIOUID(ETHYLENE GLYCOL 0 0 i : tf: i33 i SOLUTIDWSI W 2. 3. 4. 14,Special Handling Instructions and Additional Information / NAERG 1 9E1:171-kPRDFILE i 9Eli:DY4i44iS3:b'":EMERGENCY CONTACT:CH_PFTfREC 1-800-4 24-53ruti TN ADDIT-fONAL EF'A CODES:5Bi:,NONE*APPRO"RIA T—L PERSONAL PROTECTnV£EQUT)VENT 11 :�O 15. GENERATOR;I 7OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marketl and W IIed/placarded,and are in all respects in proper condition far transport according W applicable meson 'naland nafi al g ernmenbl regulations.If export shipment and I am the Primary Exporter,I Fat that the contents of this consignment conform to the terms of the attl EPAAcknowl gment of I. I certify Mal",Weste minimization ata aiSImnfified in 40 CFR 26217(a)Cd am a large quantlry gen r)or(b) I am a s entity geraul )is We. Generator' Pedlfyped Name SigAa M tit Day Yar 16.Intemalicnal Shi mens p— C]Import to U.S. ❑Export from U.S. Pon of entrylexit z Trdnsponer a gnalure(for exports only): ate leaving U.S.: / C 17,Transporter Ar nowledgmentof Receiptof Materials > >/ u Transporter�dnledRyp fine / t Signatu — ~ / ti1n �a Yj n ad. Transporter 2 PdntedffWedName Signature Month Day Ye 1Z r� 18.Discrepancy 18a.Discrepancy Indicalion SpaceQuana ❑ ty ❑Type ❑Residue ❑Partial Rejection ❑WII Rejection Manifest Reference Number: 18b.Altemam Reality for Generator) U.S.FPA ID Number U LL Facility's Phone: 18c.SgnaWm of Ailemate Facility(or Generator) Month Day Year Q z y19.Hazardous Waste Rimaq Mapageupent Method Codes(i.e.,codes for hazardous waste reaMent,disposal,and recycling systems) In 1. 2. 3. 4. y 20.Designate Fa 18y Owner or Op tor.Certification of receip f hazardous matedais covered by the manifest except as nsmr Pdnled7fy N / //, r. SignaNrB.,� the Ory. Y EFA Porro 8700-22(Rev.3-05) Previous editions are obsolete. t7 ?!^`lA aJ FACIL!TrTO D_3 iNA-i)ON S"dAi_ =D;