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Please print or type.(Form designed(or use an elite(12•piteh)typewriter.) Form Approved.Okffi No.2050.0039 <br /> UNIFORM NMR00US1•Generate IDhumber 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST t: E,'�� ti �, 1} t vt7; 424--�r30c 014055626 JJK <br /> 5.Genere!ors(lame and 1.4ftgAddiess Generator's Silo Address(if different than mare address) <br /> JIFFY L11BE`698. <br /> 11>30 N. MAIN ST I��17 N MAIN ST <br /> MANTEC'�A CSA `}r,„3L' MANTEC C:A �)f,t_t�, <br /> Generalo'sPhone: 209 239-0665 <br /> 6.Transporter!.Company Narre U.S.EPAID Number <br /> At:B1sRY ENVIRONMENTAL SERVICES G A D O 3 E1 2 7 -7 0 3 6 <br /> 7.Transporter 2 Company Name U-S.EPA 10 Number <br /> 8.Designated Fac,' Name and Site Address U.S.EPA ID Number <br /> DK 'D1 1'i <br /> 7300 CH!?VRGId WAY <br /> UIxON CA 9.5620 <br /> Fao': sF"now: (707)6.9)3-6008 CAT O B O n I :3 <3 U 2 <br /> i <br /> 9a. °b•U.S,DOT 0escripton{including Proper Shpp:ng Name,Hazard Class,ID Number, W.Containers 11.Tota! 12.WR 13.Waste Codes <br /> tU,t and NcKt 6 Group(if any)) No. Typo Quantity W1Nol. <br /> 1' NON-RCRA HA'LARI)OUS WASTE, LIQUID (OILY WATER) <br /> 2. <br /> LU <br /> 3. <br /> J U L 2 7 207 _...___._.. ..�__ <br /> 4. <br /> ENVI gCAPAENTAL HEALTH _.. ._.._......_._ ...._.___. <br /> 14.Specrai 1{anOng Instneons and Additional lnformatan <br /> NMRG0 9B1 : 171 t PROFILE # 9B1 1 DK100110 #AEMERGENCY CONTACrt CH.EMTREC 1-800- <br /> 6.24-9300 :� ADDITIONAL FPA CODE36 i 9B1. I r NONL } APPRE)PRIATE PLRSONAL PROTECTIVE <br /> EgUIPMENT -7-d uL& 10 7 C <br /> 15. GENERATOWSIOFFEROR'S CERIIFICATION:I hereby declare Ihal the contents of Us conzgement are fttyard accurate,,/described above by the proper$4 ng name,and are daaed,packaged, <br /> marked and tabe'ed'placarded,and are in a8 respects In proper condition for transport accoffng toappltab;e international and natonai gmemmental regulations.If exportsh`pment and I am ft Primary <br /> Exporter,I ceruty that tho contents of thi'stnnstgnmentconform to 0w terms of the attached EPAMAvA'edgment of ConsenL <br /> I cettit that the vm5bo ml4 iiaton slalement identified in 40 CFR 262.27(a)(f I am a large gaantty gonetalor)or(b)(if am as O quanti!"slialoo is true. ? <br /> Gsvterabfs93fesor'sRrintecirllp@dNamo+ agname i htonth Day year <br /> v�t�tt 4v s �i c� <br /> -1 16.InternationalSNP(nents <br /> ❑Impod to U.S. ❑ExpoA from U.S. Port of entrylexil: <br /> Transporter sgnalura(fof e)porls only): Date teavng U.S.: <br /> 17.TransporterAckrt VedgmentofItece'ptofh(ateda's <br /> jTe Transporter I Pri tedlryped Name Signature h'Arrth Day Year <br /> d1w 41 <br /> Ua v. <br /> Transporter?Pfinled/TypedNameSgnatuce I.tanlh Day Year <br /> H '-s <br /> f8.Disc1Wr y <br /> 188.Discrepancy ledcaWn Space ❑quantity ❑Type ❑Res!duo ❑Pallial Re;•ecton ❑Fu'1 Resection <br /> Manifest Refeienco Number: <br /> 18b.Aiternite Fa6i,ty(o(Gereralot) U.S.EPAID Ifumber <br /> .J <br /> V <br /> US Faotty+ Phare: <br /> W 18c.S gnabxe OfAlto Fav ty{a Gonerata) Month day Year <br /> Z <br /> 19.Hazardous Waste Report Management?,lethal Codes(i.e.,codes for hazardous waste treatment,disposal,and regcI4 systems) <br /> 4, <br /> 20.Designated Facility Uaner or 0perala:Certilicat'on of receipt of hazardous materials covered by the manifest except as nded rn Item 183 <br /> Prinled7Typed Name Signa A'urith Day Year <br /> Qr ,I / z <br /> EPA Form 8700.22(Roy,3.05) Pd <br /> Otis ocir,onsare obsotelo. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />