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Dlanen ndnr nbwei2/cnim destined lnr uee ale elan H9_ni4Flbrowrilerl ' <br />Form Anomved. OMB No. 2050-0039 <br />eyArbmnluu22(Rev.3as) PrevlousedlV0n58re0DS0lete. v DESIGNATED FACILITY TO GENERATOR STATE (H- HEcaUfRtu) <br />UNIFORM NAYARDOUS 1. GemmlarlDNumba" <br />2.1agelof <br />3.Emergenry Response Phonal <br />4. ManlfestTracking Number <br />JJ K <br />WASTE MANIFESTC T L 0 0 0 2 S 9 3 7 5 <br />X860 434-9306 <br />009894590 <br />5. Gemminfs Name and Mailing Address GenemtD(SSM Address (if ddferent then moft address) <br />PICK N PULL Y80 <br />3927 CLARK DR <br />STOCKTON CA SWIM <br />Generator's Phone: X94132-1:(27 <br />` <br />6. Transporter l Company Name U,S.EPAIDNumber <br />ASBURYEiPARONNENTALSERMCES C A D 0 2 8 2 <br />7 7 6 <br />7. Transporter 2 Company Name U.S. EPAID Number <br />8. Designated Fadity Namaland Site Address U.S. EPA ID Number <br />' <br />DENENNO1KERDOON <br />2cm N. ALANEDA STREET <br />COWTON 6A c1:122 C A T 0 8001335 <br />2 <br />Fau1i s Phone: 01OW-7103 <br />go, <br />9b. U.S. DOT Description (mdudmg Proper Shipping Name, Hazard Class, ID Number, <br />10. Cantsinem <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Grog any)) <br />Quanfiy <br />WANoi. <br />o <br />1. <br />NON •RCRA HAVACOUS WASTE, LIQUID (USED OIL7NAXE0 OIL <br />WITH SODIUM SILICATE) <br />D Fid <br />UU <br />2. <br />3. <br />4. <br />14. Spedal Handling lasWctans andAdMonal lnfomution <br />ENIERGENCYCONTACT :NEMEC 1-MV-424-MNAERGO9B1:171' PROFILE f9B1:OM12USED 01L&IXEOOIL <br />W1THSODIUP41GILICATE'POO A110152831'APPROPRIATE PERSONAL PROTEC TIVE EQUIPNENT <br />15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignmentare fltyand accumteiydescribed above by the pmper shipping name, and ore classified, packaged, <br />marked and tsbeledfldecarded, and aro h ab respects In proper condition fa bamport according to appikade Inmmabonaland natbnal govemmenlal regulatlau. If export shipment and I am Ne Primary <br />Exporter, I ceNy that the contents of this consignment omferm to the terms of the agadwd EPAAdrowledgment of Consent. <br />I certify Natthe waste minimization statement Identified In 40 CFR 262.27(a) (if l em a Igo quantity generator)of [b) (dl am a small quantity gemmla) Is We, <br />GeneratodslOfiaofs PrinledfTyped NameJnr {lam nature /`/ <br />Moonntthh '}Day Year <br />J <br />F <br />18. International Shipments <br />11 Import to U.S. ❑Eaw hen U.S. Podarenhylaxib <br />= <br />. <br />Transporter eignelue(for exports only): Date leaving <br />K <br />17.TmmpoderAdvlesledgmentuf Recdpta(Matedeis <br />N <br />Slgm <br />Monty Day . Year <br />Trens 1 PdnkdRypnd Name <br />G2 <br />l� <br />N <br />Zatransportor <br />r -' <br />Print dName S a <br />Monty Day Year <br />18. Discrepancy <br />18a. Nadrepancy Indication Space ❑ Quantity ❑Type ❑ResIdue ❑Pertlal Regal <br />❑Full Refection <br />Manliest Releferce Number. i r <br />186.N(ema(e Fadgy for Generator) U.S. EPA ID Number <br />J <br />U <br />sa <br />FaciNs Phone: <br />a <br />2 <br />18c. Signature ofAllemate Faci ity (a Generator) <br />Monty Day Year <br />19. Handouts Waste Report Management Medved Codes (Le., codes for hazardous waste heabmnt, disposal, and recycling systems) A, <br />-' <br />G <br />1 / /0 <br />2. 3 <br />4. <br />28, Designated Fadlity Owner a Operator. Certification of facelpt of hale rduus materials covered by the manifest except as noted In item 188. <br />do yped Name Sig <br />MerrillDay Yew <br />0 <br />i <br />eyArbmnluu22(Rev.3as) PrevlousedlV0n58re0DS0lete. v DESIGNATED FACILITY TO GENERATOR STATE (H- HEcaUfRtu) <br />