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L`1v.tr.. VJI�V• 1LL <br /> i <br /> Plgase print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 7Paeof 3.Emergency Response Phone 4.Manliest Tracking NumberWASTE MANIFEST CAL000011032 (800)424-9300 013 303802 JJ K <br /> 5.Generator's Name and Mailin Address Generator's Site Address(if different than mailing address) <br /> )IFFY LUBE 059 1130 N MAIN ST <br /> 1130 N. MAIN ST CA 95336 MANTECA CA 96336 <br /> MANTECA <br /> Generators Phone: 209 239-0665 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES ICAD028277036 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated p Facility Name and Site Address U.S.EPA ID Number <br /> 7360�CHEVRON WAY <br /> Facility's DIXONXQ CA 85520 CAT 0 6 0 012 6 0 2 <br /> 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity wt./vol. <br /> 1. <br /> w PJAAI Df%DA UA7AD11A11C VAIACTC 1 1^111111 J'All V 1AfATCDI A A I T T <br /> O IAV It1l Vltli I Ipq J 11VwuJ •IAJIL, uaju l\/ wliI 99M.1-11 v v 1 1 1 uIII <br /> cLs <br /> V <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> NAERG# 9B1: 171 m PROFILE #9B1: DK100110 b*EMERGENCY CONTACT' CHENITREC 1.800-424-9300 <br /> ADDITIONAL EPA CODES . 981; , NONE ' APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified.packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quanti rator)is true. <br /> Generators/0 e s Printed/TypedSignature Month Day Year <br /> M&i l� 1 <br /> 16.Intematio I Shipmen <br /> F- ❑ mport to U.S. Export from U.S. it of entry <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Pnnted/Typad Na Signature Month Day Year <br /> O `/ <br /> a <br /> Z Transporter 2 Prnted/TypffName SignatuV Month Day Year <br /> a <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity 1-1 Type El Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> t 8b.Ahemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL. Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Mon h Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. � 2. 3. 4. <br /> 20.Designated Facility OwW or Operator gerfification of receipt of hazardous materials covered by the manifest except as noted' Item 1 as <br /> Printed/Typed Name Signature �� M Day Y r <br /> P? <br /> � hf�� I <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 11871.0619 <br />