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--777777 <br /> %-777 <br /> 7T <br /> Form Approved.OMB No.2050-G039 <br /> Plea"printortype. <br /> —Men-destTrUldfig Number <br /> UNIFORM HAZARDOUS 1-Gareftlor-10 Number z.Pagel or meri expense me 4 <br /> 1 0 110 851- <br /> WASTE MANIFEST' CAR000:21�6', 54 2 JJK <br /> 5.Generator's Nam and Melling Address Gamester's Ede Address(f different than malting address) <br /> ECSIRMNINGALC <br /> =KTOK95215 STOCKTON <br /> Oarvirestoft pharly. 40e.200400�� . <br /> U.S.EPA ID Number <br /> ASBURY ENUAMMEN TAIL SERVill <br /> 7.Trwspwtw2CornFwi <br /> 7—SEiAID umber <br /> 8.Designated Facinty Name and Sidifieldress U.S.EPA ID Number <br /> -71 CA 50222 <br /> Fai Phone: 00 <br /> 9, Ste.U.S.DOT Description(including proper Shipping Name,Hazard Closer 10 Number, 10.Containers 11.Total 12.Unilt 13.Waste Codes <br /> HM and packing Group(ff any)) No. i Quantity wtivol. <br /> 1, NON-RCRA HALARE)OUS W.M.-Illf,LIP(OW"ll GLYCOL 0 is <br /> 2. <br /> uj <br /> CD <br /> 4. <br /> 14.Spatial Handling Instructions and Additional Information <br /> 96i:t. przorxi AF*EMERM.-AC CVATACT;CHIEW11i 1-80042441,300 AVM'K,'M^A ;,EPA <br /> FROW0,YWEECS y MERT <br /> 6 <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare Net the dentemani consignment are fully and accurately described above by the propershi name and are closeffied,packaged, <br /> marked and lateeled/placarded,ani a]respects;in proper coni fortransidart according to applicable Intensional and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I call thatthe contenti consignment conform to the teas of the attached EFAAckruviledgment of Consent. <br /> I certify that tho.vniste minlmizalon,stawmanildai in 40 CFR=27(a)(111 am a large quantity gsmratoqqj�1bXffI am a small quantly,generator)Is(rue. <br /> GenneragMtrIeror's Print wi I, 3 Filli --—------- Month Day Yeyar <br /> 1 1 1 <br /> 16 IntemabonsISNuxurns import to U.S. LJ Export from U.S. port-1101-adt <br /> Transporter signature(for exports only): o Date leaving U.S.: <br /> 19 17.TransiomerAdrvowledgmantof RacelptolfMatemals <br /> Month Day Year <br /> Trans <br /> Printulftypedi '17 Signature <br /> X9tell <br /> Transporter 2 PrinlenlRyped Nunn Signature Month Dey Year <br /> 18 Discrepancy <br /> 18a,Discrepancy Indicated Spam E] Courtly RECEIVWdu PartW Rejeadan El Full R.Jeocicm <br /> enifest Reference Number. <br /> 18b.Alternate Facility(or Cenemtor) U.S.EPA ID Number <br /> LL Facility'sPhome: <br /> 78d—,SlpAltennaiw Faclily(or Generator) <br /> it I. Month Day year <br /> z <br /> 29 19..Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Vestment disposal,and recycling systems) <br /> @ . 1 4. <br /> 2. <br /> 20.156slignated Facllfty Owner or Operator.Certification of receipt of hazard0immosterfals covered by the an ap'as inded in Item 1 Be <br /> an Day You <br /> Cc clell> <br /> EPAForm 8700-22(Rev.3-D5)'Previousgottions are obsolete. DESIGNATED FACILM TO GENERATOR STATE(IF REC1111111TED) <br />