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i <br /> Pleasaprinlor"a.(Fomt designed for use onelile Itch)typeutec) - Form roved.OMD No.217500039 <br /> UNIFORM HAZARDOUS /•�nerebrlD Number— 2.Page tel 3.ErmsgerwyReaprou.Pha,, .tlan8asl Traehing Numher `WASTE MANIFEST p 0 s 5 i 900 424-9300 1 011827255 JJK <br /> 5.Gemralces Name and Maft"ress <br /> PICKNPULL#80 cipxearasgeAddren(YmBrartga meSgaddm) <br /> 3927 CLARK DR 3927 CLARK DR <br /> STOCKTON CA 85205STQCKTOM CA 86205 <br /> Garimle(s Phow, 9iG 699-2000 q - <br /> V.[Iva"l Company Nemo U.S.EPA ID Number <br /> SBUR <br /> Company Name <br /> NTALSERVICES AD028277036 i <br /> 7,Transmuer 2 US.EPAID Manlier <br /> 8.Deslgnaled radlity Name and Site Address U.S.EPAID Number <br /> DK DIXON <br /> 7300 CHEVRON WAY <br /> DIXON 85620 <br /> PPhcna: .60 8 <br /> F A T 0 8 0 012 6 0 2 i <br /> 6a. 9b.U.S.DOTDesedpEon(Indudug Proper Shpping Nan,,,Haaard CIM,I0INIanbe6 10.CoNahwe it.W 12.Until F08 end Patting Cvay(Xany)) Na TYPa 4ueeft NRAd. 13.Wade CaOea i <br /> lz �AOH41CRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL), 0 01 rT00 221 <br /> —� <br /> t <br /> W l <br /> all <br /> I <br /> 3. <br /> 4. i <br /> I <br /> 14.Spedal Harding lminacshm endAddlganal lnfonnatlon <br /> NAERG# 981:171°PROFILE#981:DK100184 EMERGENCY CONTACT:CHEMTREC 1-800.4249300 <br /> ADDITIONAL EPA CODES:901:,NONE* �R, PERSONAL PROTECTIVE EQUIPMENT i <br /> 15. GENERA70R'SIOfFEROR'S CERTIFICATION:Iherehydedvethat 0,,antenis ofthisc«ngnment are tdlyandacovaleyclownhed above by the propersKVpeg name,and we dassifted,padmged, <br /> marked and lab"placerded,and are In agraspecfs in propermrdmon ran imnspod according to applicable lnlerratlonaland national govenunenlairegulatlam.11 aped shipment and l am the Primary <br /> EVorteh Icerdfythat the omtenU or Nb conslgnmenl mMorm to the lermof the attached EPAAcbweiedgmentolConseni. <br /> I cod ythat thewasle mlrimaeon statement Identified In 10 CFR26227(a (91 am a Inge quanulygereralor)of(b)(11 am a smal quanttyger,,rator)is We. <br /> Genenbfs101fenfs Priled7(yped Name Slgnahve fionh Day Year <br /> —s 16.Inleunwom151pments <br /> F Impo U.S. ❑Export 4.U.S. Podofentry <br /> Transporter sign dare(for exports any): Date havng U.S.: <br /> 17.Tmroale Mo1R of orals <br /> a. Tra yped Name Signa Month Day Year <br /> a <br /> az Tra - le ed Name S{g bion Day ear <br /> r18.alsaapancy <br /> IM.Discrepancy Indication Space ❑ fitly ❑Type ❑Rat. ❑PaNal Rejection ❑FW Re acd <br /> 111 f <br /> Manifest Reference Nwnber <br /> leb.All male FeWly(ar Genen or) U.S.EPA ID Number <br /> J y <br /> Q <br /> LL FaaHya Phone: ' <br /> W 18n.Slgnelun ofAllernale FaeAy(,Genenlor) Man0 <br /> Q DO' 'her <br /> I i <br /> 2 t <br /> y19.Hazardous Waste Report Management hleawd Codes Q.e.,cedes for hszardoua waste lreabneM,disposal,am recycfing system) <br /> 3. 4. i <br /> i 20.Deafgnand Faaliy Ovmerw Operator.Ceditcathn ofm4lorhazardausmetadels mneme)by the rnarilesl except as Med In llem l9a <br /> PritedRyped Nanon, SIBnaVe Man Day Year i <br /> c� 1G�Sc e y1a q o 2t 6 <br /> EPAForm8700-22(Rev.3-05) Previousedillons are obsolete. DESIGNATED FA TO DESTINATION STATE(IF REQUIRED) <br />