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ay — <br />PleasemAntol Nnn.(Fnrm dasMnad fnr use nn sill. floAtAl bnawire.I <br />UNIFORM HAZARDOUS I•GeneatorlDNumborPage <br />l of <br />i' <br />3. Emergency Response Phone <br />. Manifest Tacking Number <br />WASTE MANIFEST C A L 0 0 0 2 6, 9 3 7 5 <br />800) 4224-9300 <br />1009821496 JJK <br />5. Gen R �1lamga(IdLMadingAddress - Generator's 5iteAddiess(it different Ilan murang address) <br />YY�I:A27 <br />CLARK DR. <br />STOCKTON CA 96205 <br />Generab's Phone: 2IM4b2-1-T7 <br />(I.Transporter l Company Name U.S. EPA ID Number <br />ASBURYENVIRONNENTALSERxAOES C A D 0 2 0 2 7 7 0 3 6 <br />7. Transporter 2 Company Name U.S. EPAID Number <br />8, Designated Facility Name and Site Address VS. EPA ID Number <br />DE ENNO / KFRDOON <br />MO N. ALAALEDA STREET <br />RWTON CA SIM, 0 1 3, 3 5 2 <br />C Am _ 0, 8 g ' <br />"' P 13101537-71Cfl <br />F dPlgne� : <br />ga, <br />-"96; LLS. DOT Description (Including Proper Shipping Name, Hazard Class, 0 Number, <br />and Packing Gmup(ffarty)) <br />10. Containers <br />12 <br />I& Waste Codas <br />Na <br />Typo <br />..HM <br />Ou <br />Quantity <br />Wd. W,Unh <br />Q <br />� <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILAWED OIL <br />j <br />�/ <br />D <br />� � <br />WITH SODILUMSILICATE) <br />/°x <br />� <br />rr3 <br />� <br />I <br />3. <br />' <br />4. •/ <br />14.8pedMHaMgngin UucWsandAddltionallnformabm <br />EMERGENCY CONTACT: CHEIVITREC 1 -MD -424 -MM VIER04901 : 171 "PROFILE 99131 : MV USED Clumm OIL <br />III S0131UMSILICATE -FO#Al101G2 B1 APPROPRIATE PERSONAL PROTECTIVEEQUIPa1_NT <br />' <br />15. GENEMTOR'SIOFFEROR'S CERTIFICATION:'I hereby declare that the wnlenls ofthls consignment we fully and accoretely described above by the proper shipping name, and are classl8ad, packaged, <br />`marked and labeledfplacarded, and are In all respects In proper condition for transport according toopplkable Intematienaiand national governmental regulations. N export shipment and I am the Primary <br />Exporter, I cem y that the contents of this wnsignmentconfonn to live tenns of the attached EPAAptnowledgmend of Coment. <br />I wrfify that the waste minimization statement idonti5ed In 40 CFR 262.27(a) IN I am a large yuandry generator) or (b) (111 am a sma8 quantity geneatoo is W e. <br />enerelo/s(011emes Pdnled/TNrame '((� (� �(�\ .1S re 1 <br />Month Day Yew <br />1 1 ' <br />J <br />F <br />16. international Shipments /f <br />EJ Import to U.S. ❑Expartharn US, Poftofentowd <br />= <br />Transporter signmum(for exports only): Date leaving lk5.: 1 <br />17. Transporter Acknovvedgment of Receipt of Materials <br />N <br />Tans r 1 PdntedfTy Name Signatu - Da , Year <br />Day <br />Iia I L <br />Tran5porter2Pdntedf1yped'N8me Sign la Month Day :Year <br />f.. <br />18. Discrepancy <br />10a, Discrepancy Indication Spacs ❑ Quavery ❑Type ❑ Residue ❑ Partial Reledlon `: . ❑ Ful Rejection <br />/ , <br />Manifest Referenes Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />LL <br />Fadglys Phone: ,, , <br />180. Signahxa ofAllemale Fadliry(or Generator) :: Month LDay year <br />Vi <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Veatmeol, disposal, and recycling systems) <br />W <br />1 <br />2. 3. <br />_,q - .. .., .. <br />O� <br />{ry <br />20. Designated Facility Omer orOperator: CerARwBon of receipto(hazardeus materials covered by the manifest except as tided. IBa _ n <br />1 <br />Put Name /J--/�—��-.-'�'^�"' S naturq�-) + Momh Day r' <br />= <br />_ <br />t'..,.n,,, ,.,r«lnox. v.ej navmus canons mu Y.'... <br />\ <br />a DESIGNATED FAMITYTO GENERATOR STATE (IF R O IRED)� <br />