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Please print or type.(Form designed for use on elite(12-pitch typewriter.). - Form Apptov Nd.2050-0039 <br /> UNIFORM HAZARbOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phoned.Manifest Trecking Number <br /> WASTE MANIFEST 'C A L 0 0 0 3 5 8 4 2 6 800 424-9300 0-66F9-- 008482515 -JA <br /> 5,Generafors Name and Mailing Address Generators Site Address(i different than mailing address) <br /> PICK N PULL AUTO DISMANTLERS PICK N PULL AUTO DISMANTLERS <br /> 10850 GOLD CENTER DR,STE 325 4223 CLARK DRIVE <br /> RANCHO CORDOVA CA 95670 STOCKTON CA 95215 <br /> Generators Phone: 9 1 6 8 5 8 - 3 1 1 6 <br /> 6.Transporter 1 Company Name - U.S.EPA ID Number <br /> FREMOUW ENVIRONMENTAL SERVICES INC TRANSC A R 0 0 0 1 7 1 0 1 7 <br /> 7.Transputer 2 Company Name U.S.EPA ID Number <br /> f,29"V*4aBeRBORS ENVIRONMENTAL SERVICES INC MA D 0 3 9 3 2 2 2 5 0, <br /> 8.De led Feality Name and Site Address, U.S.EPA ID Number <br /> CEAN HARBORS <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE CA 95133 <br /> F861' s hone: 408 441-0962 C A D 0 5 9 4 9 4 3 1 0 <br /> 9a gb.U.S.DOT DescdDOon(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total Q.Unit 13.Waste Codes <br /> HM Paclmg Group('rf anYl) No. Type Quantity Ili <br /> 11: 1 UN1993,WASTE FLAMMABLE LnUIDS, N.O.S.(GASOLINE, DOO D01 343 <br /> 0 DIESEL)3,11 --77 �7 <br /> ,= G. DM 1 /0 G <br /> W 2, UN1993,WASTE FLAMMABLE LIQUIDS,N.O.S.(GASOLINE D001 D018 343 <br /> c� RINSATE) �� G <br /> 3, 11 _ Z DM <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions andAddkonal Information 1)CH 435610-Mixed FLK-AS ERG0128 2)U 1471650-Gasofirw Rifisate ERG#I:,8 <br /> `7,T '<)I '-; 134 HANDLERS 7U BE 40HR 17AINEI)AND USE PPL. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consgnment are fully and accurately described above by the proper shipping name,and are classified,packaged. <br /> marked and IabeleNDlamrded,and are in all respects in proper condition for transport according to applicable international am national governmental regulations.It export shipment and I am the Primary <br /> Exporter,I certity that the contents of this ccppnsignment conform to the tens of the attached EPA Acknowledgment of Consent. <br /> I wr*that Me waste migimijation stalemNnt Identified in 40 CFR 262.27(a)(ff I am a large gyantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratorslOfferors PnnWgyped Name signature Month Day Year <br /> qq <br /> J 16.International Shipments ElI <br /> F Import to U.S. ❑Export frym U.$e" Port of enVylexh:: <br /> Transporter"nature(for exports only): • Date leaving U.S.: <br /> K 17.Transporter Acknowledgment of Receipt of Materials <br /> KTransporter i Prinletllryped Name Signature Moth Day Year <br /> a ( o l <br /> Z Transporter 2 Printed/ryped Name Signature ".�L Month Day Year <br /> 1B.Discrepancy ' <br /> t 18a.Discrepancy Indication Spam ❑ QuanMy ❑Type ❑Full <br /> El El Partial Rejection Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(o Generator) U.S.EPA ID Number <br /> J <br /> U <br /> u Fedlilys Phare: s <br /> 18c.Signature of Alternate Facility for Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> N <br /> 2 1. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous{yl 3. <br /> materials covered by the manifest except as n9a, in Item 18a <br /> PdntedfTyNd,'1�rge 7- .Signature Man D Year. <br /> fi/ <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNAT ACILITY TO GENERATOR <br />