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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-9 J See Instructions on back of pr 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(I -pikh]Vp, r. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST d )- 0 a 101A 11 13 1,5171P Q (J y 9 1 OF <br /> 3. Generator's Name and Mailing Address ^� C A. State Manifest Document Number <br /> ,,,,, ICJC�C/`e,R�T+W{) 24600990 9 <br /> Cp r <br /> N55 591 5.151 s B. State Generator's ID <br /> L r ,,�,.�. , CQ,, q H5.5D <br /> LO A. Generator's Phone ( ) .4l..YC/t/1; <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> L00 <br /> O hC <br /> o ASBURY I_N111RONNEN TAL SERVICES C Ilk D U 2 8 7 7 7 0 3 6 D. Transporter's Phone )gJq-dA J <br /> 7CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID(Reserved.] <br /> 'Q F. Transporter's Phone <br /> U 9. Designated Facility Name and Site Addre is 10. US EPA ID Number G. State Facility's ID <br /> a DK WON <br /> 3— 7300 CffEVR(-)N WAY 1 ) <br /> W H. Facili s ho e <br /> r° DIXON CIA T 0 8 0 0 1 2 6 0 <br /> �U 11. US DOT Description(including Proper Sh pping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. Type Quantity Wt/Vol I. Waste Number <br /> T NON-RCRA HAZARDOUS,Wk' TE,LIC"D (USED(AL/M*D l st�a�te <br /> O N b. State <br /> NAR <br /> co E <br /> EPA/Other <br /> 4 R <br /> A C. State <br /> o T <br /> coo O <br /> R EPA/Other <br /> cle <br /> LU d. <br /> State <br /> Z <br /> LU <br /> U EPA/Other <br /> LU <br /> rn J. Additional Descriptions for Materials Listed k6ovi. + K. Handling Codes for Wastes Listed Above <br /> Z USED OIL/WED COIL1 r ( ® b. <br /> V) <br /> W <br /> Cie C. d. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additio al Information <br /> USE PPE , 181.t71� ENE-RGENCY OMACT-CHIEMMEC II-OW424-M <br /> Z NAERG#. I IIA 17'1 �,�vt s-rD 440-dow ✓est, , <br /> W <br /> 16. GENERATOR'S CERTIFICATION: thereby eclare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respe is in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> J If I am a large quantity generator,I certi that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a- practicable and that I have selected the p cticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> V) and the environment;OR,if I am a small 4uantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> a-' available to me and that I can afford. <br /> O <br /> } Printe /Typed Nome Signatur Month Day Year <br /> Z 100 140 G G. <br /> LU T 1 . Transporter 1 Acknowledgement of Recei of Materials <br /> LU R / Month Day Year <br /> LU p Printed/Typed Name Signature <br /> r( <br /> W ar R l-} C) 18 10140 <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> w E <br /> R <br /> V 19. Discrepancy Indication Space <br /> F <br /> Z <br /> _ A <br /> C <br /> I <br /> L <br /> f20. Facility Owner or Operator Certification of ecei t of hazardous materials covered by his manifest except as noted in Item 19. <br /> T <br /> Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />