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DTSC. 01627. 0791 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.20SM39 <br /> UNIFORM HAZARDOUS L GeneraterlDNumber 2.Page l of 3.Emergency Response Phone 4.Man hest Tracking Number <br /> WASTE MANIFEST - C A 0 0 0 2 6 6 3 2 T 9 1 00).11124e9300. 00 <br /> 81-41062 JJK : . <br /> 5.GennW0 TMdress Generators SiteAddiess(If different than me ling address) <br /> 246 N. UNION ROAD 920 W. CENTER STREET <br /> MANTECA CA 967 M4NTECA CA: .96367 <br /> 2D9&56-19M <br /> Generators Phone: <br /> 6.Transporter l Company NameS ,r ILS.EPAIDNum <br /> ASBURYENVIRONNENTALSERVICES .• .,,.,. _:. cog:.:: .. C A D ,2 B 2_T;7 _0;3':6 <br /> 7.Transporter 2 Company Name .�, U.S.EPA ID Number <br /> 7 <br /> S.Des V"Nar� 'ass U.S.EPA ID Number <br /> 2000 NORTH ALANEDA STREET ' <br /> m <br /> C.OWTON CA 90222 `0 Tar,t'•e F <br /> _, . <br /> grew CAT <br /> (3101537-7100 <br /> 0 B 00 •Y3352 <br /> F aPhone: - .:r....» .. ... .-. ... .:.-� <br /> 9, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Cohabiters 11.Total 12.UM 11 Waste Codes <br /> HM and Packing Group(dai No. Type Quantity Wuvol. <br /> o NON-RCRA HAZARDOUS WASTE,LIQUID (OILY WATER) <br /> OO.q ,T T., L4qD <br /> G w: <br /> z 2. <br /> W , <br /> (7 � <br /> 3. <br /> 4. T-F <br /> 14.Special Handling instructions and Additional Information <br /> NAERGO 9131 : 171 'PROFILE 0981 OW20KC ENERGENCY CONTACT:CHEMTREC 800-4241300'ADDITIONAL EPA CODES <br /> 981 :,NONE'APPROPRIATE PERSONAL PROTECTIVE EQUIPNENT, <br /> �w,#14L/)A9),1.2_TL2 L <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:1 hereby dedere that Pre contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeadiplaarded,and are in all respects in pmW condition for transport aocreding to appfigble international and national governmental regulations.If;xport shipment and I am Ore Primary <br /> Exporter,)certify that tine contents of this ansrynm cot conform to Na tams of the aoached EPAArknowledgmem of Consent. <br /> I catty that the waste minimi7adon statement identified in 40 CFR 262.17(a)If I am a large quantity gene2ur)or to)(if I am a small quantity generator)is no. <br /> GereraWrs108erc's Pnntedr<yped Nacre Signaara Mpnth Day Year <br /> Aj ¢ . Fq^Joy 14 <br /> F 16.International Shipments El Import b U.S. El law ham U.S. Pat ofenhylmdt <br /> Tramporter signature(for exports only): Dale Having U.S.: <br /> W 17.TrasporterAdmaNedgniam of Receipt of Materials <br /> Transports 1 RintedRyped - Signature ', Math Ory Yea <br /> y �er� Oen S O DY / <br /> Transporter 2 PrintedRyped Name SipaMw Momh Uay Yea <br /> C <br /> r <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ QuantityResdue Rejection Rejection <br /> El ❑ El Re clan Full <br /> Martino Reference Number <br /> 18b.Alternate Facility(or DenereWr) LLS.EPA ID Number <br /> J <br /> V <br /> tea. Facility's Phone: <br /> cow 18c.Signature of Alternate Facility(or Generator) Monty ay year <br /> 2 <br /> S2 a <br /> 19.HaaaNs Waste Report Management Method Coda(i.e.,codas M haeme.waste treatment del and recycling systems) <br /> 1. 2. 3. 4. <br /> D <br /> 1 20 Designated Facility Owner or Operator CenlBadon of receipt of hazardous materials covered by th manifest except a Med in Ism 18a <br /> pv2jypedl ams 'gnaw Year <br /> 03 104111 <br /> EPA <br /> Fohn i 700-22(Rev.3-05) Previous editions are obsolete. SIGNATED FACT TYTO DIESMATION STATE(IF REQUIRED) <br /> 10896.0606 <br />