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Jun 03 2008 2: 29PM COX BROS TIRE SERVICE 60,401 <br /> Stale ariCalifornia—Emmrec <br /> ironmtal Prolion Agency J—j}„j vY—O� P• 6 <br /> Form Approved OMB No-2050-00391Expires 9-30-99) See Instructions on bacage 6. Deportment of runic Substances Cor <br /> Plema print or type. Form designed for usean NRe f]2-pikA)typewriter. S«romanro,California <br /> (FORM HAZARDOUS 1, Generator's US EPA ID No. Monihat Document No. 2. Pogo 1 Information in the shaded areas <br /> r WASTE MANIFEST CAA)-?820 1074' 1 47035 1,no,required by Federel low. <br /> d <br /> m 3r'Generator's Nan andMaill Address ., :') . - N+PnfIM'f DaFlvsae7t <br /> 5£7 E AV' 97" <br /> a <br /> TRACY CA 95376-40Y6 * h <br /> A. Geaeratar's Phone 1 2431 CI'35-08513 r, <br /> .0. S. Transporter Ca mpany Name 6. US EPA ID Number <br /> $s.IFtTY—ALEEN SYSTEMS, INC.; rX. C ?0pr {7 30. 13 TvaAli <br /> 7. Trasporte,2 Company Name 8. US EPA ID Number .raPe}ieaaNT c� <br /> 'Fr Transpanee:s: nL; <br /> 3 9 c I5ty tW - 10. US EPA 10 Number 9hp1► aef'y f <br /> 5 6000 88TH STREET � <br /> O SACRAMENTO £A 95928 CAOOOOO8451 i• N. Fftllflys PhIsI <br /> GY <br /> 11. US DOT DecripRan Iinduding Proper Shipping Nome,Hazard Close,and ID Numbml 12. CantaIntern 13. Total 14 Unit :.. <br /> No. T e Quantity wool <br /> Z a. <br /> HAZARDOUS A9TE, LIOUI£, NJ 0. S. <br /> �i f3 9 NA:3Oe2 PQ -I- I tDO3914ER6#1711. <br /> AQUEOUS 8R!%,E �62 T T ON 4 6. 3#/,CAI. <br /> l <br /> o N b <br /> a0 qS <br /> Deo E <br /> N R h <br /> < A <br /> T s <br /> W <br /> Z +9 ;"�`C14argalb!t€+._., UgiRk' s_#. .;IR:yyrdRnll,Gzf�yefaz. . <br /> 14 <br /> a # INc7:t'k JfL4? 24HR <br /> Z S3{ AUTHORIZED TO RETAIN e_I E1VrkP 5U14SEOUENr CARRIER, AS NECESSARY. <br /> W <br /> A 939 B D <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare thetthe<anbnrsof this cormmeant—fully and am ' <br /> descrt6adabovebyprapar rhipping name and are classified,poc Fed, <br /> marked,and 1.6.6d,and are in aft respects in traps,condition for eaneporl by highway occordingdo app ica66 international and norionall government regulation. <br /> IF am a large qumfiq generator,I<erdfy that I have o pro <br /> nom in place to reduce the volume and"City of wash generated to the degree I have determined ra be aconumiccll <br /> ti. proarimble and that I h ve miscHd the pmrfico66 metled of hrm, ,ant,da o,er ds aal comm available to m which yy <br /> and the environment;OR,if I am o small uaMi P • minfmiau the present and(Wore threat to human heahh <br /> 0 9 h generator,I have made a good,faids effort p minimize my waste 9-r4milm and sele:rt the bast wash moimgnnent method 1Mt is <br /> �. ovoilable no me and then I on aFFPrd. =�. <br /> V Printed/{Typed Nam.? <br /> S' re <br /> = 44Ys C...1Y Cl l"v 31"" on Day Ypt <br /> T 17. ns ' 1 na •nam sed Race! d hh C <br /> R <br /> w A medRYPd ^�.,.� fslpnt � poy <br /> W Mc <br /> p:''Y�aor� <br /> 0 1 r Ac owl anent o Reeei t of Nrio6 <br /> T Primed/Typed Name Signature <br /> QH R Month Day Year <br /> V 19. Disarepency Indicalian Spdae - <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> I 20. illi Owner or erehr i'mten 'rocs' s of hex ovs materials covered b this momfaalexu t as meted ie Rem 19. <br /> T hintsttRypd Nome Signature . <br /> Y - '. Month Day year <br /> DO NOT WRITE BELOW THIS LINE: <br /> OTAC 8027A(1/991 Film; GENERATOR SENDS THIS.COPY TO 7TSC WITHIN 30 DAYS <br /> , <br /> FPA 11700-22Te: P-O, got 400, Sacramento,CA 9381T-O4gp <br /> t <br />