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Please print or type.:Forst clesignrid for use on elite;{12•pfieti typeilritrr; FomlAppr4i,K OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4:Manifest Tracking Number <br /> 0 7460041 JJK <br /> WASTE MANIFEST C A D Q 2 8 2 7 7 0 3 6 1 (800)424 9300 <br /> ti.Gorrr.raipr'e Ns1i�a arni Mh1m A{Idrasa, Gartii3ters Quito 'drssa(it.titTeront alas m�GTrg addrigpa) <br /> ASI3UR kNti'I*r(�tl11�11 VIAL SERVICES 13045.SANTA FE AVENUE <br /> 1300 S.SANTA FE AVENUE COMPTON CA 90221 <br /> COMPTON CA 90221 <br /> fi7ry Bator' 1tmna:' 310 886-3400 <br /> 6;TransparEita{,oiitpnnyaUBS:EPA 0 Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7 Tra000rtnr2C mpatly:Nlftw; U& cPA1p,umber <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DK DIXON <br /> 7300 CHEVRON WAY <br /> DIXON CA 95620 CAT 0 8 0 012 6 0 2 <br /> Facilit es Phone: (707)693-6008 <br /> 8a gb.U DOT Description(including Proper Shipping Name,Hazard Class,iD Number, 10.Containers 11,Total 12.Unit 13,Waste Godes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 0 1' NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OIL) 001 T T `7� G 221 ' <br /> °� <br /> Z 2.. <br /> r <br /> 3, _ <br /> l <br /> 4.: { <br /> t <br /> 14,Spec€a(Handling Instructions andAddilional Information <br /> 01101 GENCY.CONTACT:CHEMTREC 1-800.424-9300 NAERG# 981:171 PROFILE#981: DKO90014 TRUCK <br /> ADDITIONAL EPA CODES:981: , NONE *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SIOFFEROR'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 condil'ri for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,I unity that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I cortify that the waste minimization statement identified in 40 CFR 26Z27(a)(if I am a large quantitygenerator)or(b)(III am a small quantity generator)Is We. <br /> (enrrvia 01(aror s Ytinte{tf 'Ad N�:mn Sign iturd i dbnlit a j Your <br /> 0 �.. E "7 <br /> —r- 16,international Shipments <br /> t— ❑Import to U.S. �`-77 I Expes from U.S. Port of enirylaxiL <br /> Z Transporter signature(for exports only): Date leaving U.S., <br /> UJ 17.TransporterAcknowledymentof Receipt of Materials <br /> a Transporter 1 PdntadrTyped N�we (; Signzture Month bYear <br /> Z Transposer Prlrited/Typed Name Signature Month Day Year <br /> Q <br /> t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space C7 quantity ❑Type [_1 J F Full <br /> ❑Residue Partial Reaction Rejection <br /> Manifest.Referance Number:. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J. <br /> U <br /> w Facility's Phone: <br /> U 18c.Signature of AttemateFacility or Generator) Month Day Year <br /> 4 <br /> Z <br /> S9.Hazardous Waste Report Management Method Cafes(I.a.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1 � r. 2 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prr 4 yyII d Nr u• L Sr lnatlltJ t of}! Daycyr <br /> y l <br /> !?PA,Form 3700.22(Ret+3.05) Previous edit; ns iieobsolete- <br /> DESIGt4ATED €t C#3.1`I 't 4J tl Sf'li'„7 1`I{i 3 STAVE'(I''= S C IJItI IR) <br />