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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS I 1.Generator ID Number 2,Page 1 of3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST c A R 0 0 0 0 0 1. 7 0 1 1 100) 424-9300 10059 2,1 0 2-4 5 J J K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) UNION PACIFIC RAILROAD-UN1233 JOHN THOM4S 10031 FOOTHILLS FS t+ 1000 E. ROTH RD ROSEVILLE CA %747 LATHROP CA 9b330 Generator's Phone: 2W 942-6224 6.Transporter 1 Company Name U.S.EPA ID Number ASBURY ENVIRONNENTAL SERVICES C A D 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8 Designated Facility Name and Site Address US.EPA ID Number OK DIXON 7300 CHEVRON WAY DIXON CA Facility's Phone: (107) -6 G ATO 8 0 0 X 2(107)693-6(M 9a 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity M.Nol. 221 NON-FORA HAZARDOUS WASTE, LIQUID (USED OILAM,)T-D OIL) 0 0 1 T'1' 76t7 z 2. LU Dixon haS the aprorite Wnfts to — --- --- - 3 rec iv`J your�� t% and has rec -- 4. Our EPA,Q HL!rnber is GAT 0 012 602. H- 14,Special Handling Instructions and Additional Information NAERG# 991 .'M'PROALE#'991 UNI233 ADS'#1 IMP)MR-OW-0FM*ADDTIONAL EPA CODES:901 :, TONE APPROPRIATE PERSONAL PROTECTIVE EWIPNENT 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 I -small quantity generator)is true. Generators/Offerors Printed/Typed NameSignature Month Day Year p r I ")I1 1hf ; i'' �� O f 3 16.International Shipments H ❑Import to U.S. ❑Export from U.S. Port of entfTemt Transporter signature(for exports only): Dale leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature , , Month �ay[' /Year En Transporter 2 Printed/Typed Name Signature Month Day Year Q H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U ra+ Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1'. u 1L11 2 3 4. n r—1 20.Designated Facilitv Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Signature Month Day Year Printed/Typed Name 9 ��` �� kdp:j. / 111 01 1 . EPA Form 8700-22(Rev.t3 05) Previous edition re obsolete. 69SIGNATED FACILITY TO GENERATOR