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Please print of We,(Form designed(of use on e!ilo 12• itch)typewriter,) Form Approved.OMB No.20SM39 <br /> UNIFORM HAZARDOUS 1.Geneiafor ID Number 2,Page 1 of 3.Emergency Response Phone 70610 <br /> esl Tracking Number <br /> WAST MANIFEST CAI, 0 0 0 0 1 .1 3 2 i U0) 424-9300 .til 8 94 5 2 JUK <br /> 5.Gawaboes Name and Ma&V Address Gewalors Sile Address(i drfterent than mae'ing eddies) <br /> JIFtY LUBE Ar-O <br /> 1IT, N.MAIN ST 1130NWNST <br /> MXNTECA CA � � ,- rA e E,A 96. <br /> Generalot's Plane: M 2,i Ocil'r i I <br /> 6.Tramportaf i Company Name U.S.EPA 10 Number <br /> ASOURY ENVIRONMENTAL SERNACE:S C A D 0 2 8 Z 7 7 0 3 G <br /> 7.Transporter 2 Company Name J�. 9, { L. J, U.S.EPA 10 Number <br /> 8.Designated FacGly Name and Site Address L7"EPA ID Number <br /> DK WON E►VVIRON! ENTA..L HEA, <br /> 7300 CHEVRON WAY <br /> DJXON CA 9EV20 :DEPARTMENT <br /> i <br /> fao?itilPhono: x-� CAT080012602 <br /> �iC}%1�i,.�:•� <br /> ga. lm.U.S.DOT DesaWon Cvtdu&v Proper SMpptrg Name,Hazard G',ess,ID Number, f 0.Conta-iners 11,Total 12.UM 13.Waste Codes <br /> lim W4PacidngGroup(deny)) No. Type Quantity 144N01. <br /> r>; <br /> 1. <br /> NONLRCRA HAZARDOUS WASTE,LIQUID (OILY WATER) <br /> 001 ,I+'1` <br /> w <br /> 3. <br /> 4. <br /> 14.Spedal Handing Inshucttonc andAdMonal fnfarmation <br /> NAERGff 9H) : 171 "PROFILE 1t 991 :OKIWI 10"EE(VE_RCENCYCON TACT:CHElUTREC 1-000.424-M- '"ADDITIONAL EPA <br /> CODES:9BA : , NOINE'APPROPRIATE PERSONS{(.PROTECTIVE EQUIPfW—NT <br /> 15. GENERATOR!$IOFFEROR'SCERTIFICATION:llarebydedafethatthecontents ofUA omstimAtate"and accurateydescribedabovebythe proper shrppEngname,andaiedassIed,padaiged, <br /> marked and labdedfplawnded,and are in aT tespeds in proper con0m�m(or transport a=&M to appt calla intem tonal and national governmental tagu!aiions.If expor{slipment and I sm the Primaty <br /> Exporter,i axtiy thal!he contentsof M eo"yv"Aconfomn to the forms of the attached EPAAdutwiedgmanl of Consent <br /> I colt y that Uta wase mLrimizatiat slatemeni Identifsd In 40 CFR 282.27(a)(d i am a largo quantity gw4(ator)or(b)(dl am a small quantity ganeratot)is Wo. <br /> Gerwatoes107wsPrfntedli wNamo Sgrta ttor'h na <br /> Au <br /> —r 18.IMa tWrralShlpmenls <br /> Import to U.S. ❑Export(9u.s. Port of srttyfexit <br /> Transports(S$gwture(for exports or y Date lea"UA: <br /> fe17.TraasportetAduvhiedgn*nlolRewt to(MatwM <br /> ohanspor{er 1 Prin{ yped Name , ` SignaNta Month Day r r <br /> a <br /> to <br /> TfansporteT 2 Printefffypid Name Snatw_.. iiordh bay ` Year <br /> I� - <br /> 18,Mwepancy <br /> 18a.Dscrepancy Indscatim Sporn ❑Quantify ❑Type ❑ReOve ❑Partial Re)edion ❑Fµ9 Rojedion <br /> tianitesl Refererxe fiumber. <br /> 18b.Nternale FaaTity(orGenerator) U.S.EPAID Numbat <br /> V - <br /> ua- FacW y's Phme: <br /> ftSlgnaiureofAlfemaleFaafty(orGeiwator) MMU) Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(fe.,codas for hazardousvraste lteatrrieol dsposa>and recytk@ systems) <br /> 1. 2. 3 4 <br /> 20,Oestgnated FaaTty Oarner or Operator.Cer55cabon of receipt of hazardous meledals covered by the manifest except as ndod In Item 18a <br /> Prinled7Typed Name SrgnaNro hionth Day yew <br /> ] C ) �- <br /> Zt <br /> EPA Form 8700.22(Rev.3-05) Prevlouseditlonsareobsalete. DrSIGN TEb FACILITY UE INATION STATE (IF REQUIRED) <br />