Laserfiche WebLink
Please owit or tyrz, jPbiwn for use on elite(i2-piioi) Form Apljmvi-J DINTS No.2050-0039 <br /> A UNIFORM HAZARDOUS 1.Generator!D Number 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking larnbor <br /> WASTE MANIFEST CAL 000269375 1 (800)424-9300 017791931 JJK_ <br /> Site Address(iftiffo-mm than.i.iwq <br /> PICK 0 PULL 1186 <br /> 3927 CLARK DR. <br /> STOCKTON CA 95205 <br /> 209 462-1927 <br /> f; fr-o�_ I Cnalr!lfq'k-Ifne J 3,EPA tO Nuaibvt <br /> ASSURY E."IVIRON MENTAL SERVICES CAD 028277036 <br /> 7.Transporter 2 Coarp-my(Jaino ^1 IU.5 EPAIDwnbor <br /> LU lu <br /> 8.Designated facility Name and Site Address JR01,11�AFt4TAL U.S.EPA ID NumberASBURY ENVIRONMENTAL SERVICE-CERES <br /> 1920 MORGAN RD. pp-TMF-ST <br /> CERES CA 95358 CAL000393680 <br /> FactitV3 Phone: (209)541-1925 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity W(.Nol. <br /> C I d 1- NON-RCRA HAZARDOUS WASTE.LIQUID(USED OIL/MIXED OIL) 221 <br /> 001 TT J60 G <br /> 3 <br /> 4 <br /> 14,Special Handting InAnx.fio,,3 and Aildillonal InfurnDW <br /> EMERGENCY CONTACT:CHEMTREC 1-600-4-24-9300 'AReROPRIATE PERSONAL PROTECTIVE EQUIPMENT*EMERGENCY <br /> CONTACT CHEMTREC 800-424-9300 -TRUCK# <br /> 15. GENERATC[R'VCFFEROR'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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable Intsmatfonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I corilly that the contents of this cone gamont conform to the terms of the attached EPA A <br /> I carlilly that the waste minimization statement denlified In 40 CFR 262,27(a)(if I am a large quantity,,x,n,-,tM 14,,.; a small quantity generator)Is true. <br /> .................. <br /> 11:4"':"'Ihq,q'..Pi,il,I'Pyroot o <br /> LZ <br /> —1 16,International Shornents; part 0 6r, <br /> Fn to U.S. EW, U.S. <br /> Transporter signature(for exports only): pate leaving U.S.: <br /> UM 17.TrarsparterAcknowledgment of Receipt of Materials <br /> I'llal"I oily )'Or! <br /> CL 11-t,;A Y! <br /> Z Transporter 2 Pnnied[Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> L-.j Quantity Type ❑Residue F Partial Rejection ❑Full Rejection <br /> U.S.1Fb.Afterra:a Fac lily tr. EPA!O N-imbar <br /> U. F Ofilv,Phone: <br /> LOU 18c.S Ignalure of Alternate Facility,lot Generator) ............ ttlorin Day year <br /> tz <br /> IG Hazardous Waste Report Management Method Codes(i.o.,codes for hazardous waste Ifealinew.disposal,and recycling systems) <br /> LLJ <br /> 4. <br /> 20.DosignaledFacility Owner o,Operator:Cerlir;calion of,eixtipl of hazardous materlatscoverej by the manifest exc-ept as noted in Item Ir <br /> plo <br /> PA Form 8700-22(Rev.3-05) Previous editions are obe;ok,,ie <br />