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MAY-12-2005 13:50 FROM:TRACY T ' CW6. K & AUTO S 12098325307 683433 P.7 State of Califonicr-Environmental Protection Agency Form Approved OMB No 2050-0039 lExpires 9-30 99) See Instructions on back Of Deportment of Toxic Substances Control Plpa*a print or type. Farm designed for use on elite f 12 0A)typewriter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA LD No• Manifest Docnmreat Na 2 Pop 1 Information i.s rho shaded arvos u is not required by Federal law. WASTE MANIFEST C" I, 0 (f 0 ;l. ?. 1 6 o 1 q IS 6 2 2 °h ��.. 3. Gonerator's Noma and Marling Address A. Stare Manifest Doomont Number 40,,�AND AUTO SNOP 23590 _ _ '�[� �'14,rT BLVD B State Generators ID �'t 47OXtor's Phone 1 CA V) h CV S. Transporter I Company Name 6 US EPA ID Number C, State Tronsporter's ID Reserved.]in f oRY ENVIRONMENTAL SERVICES 0 0 7 7 ® D Transportat s Phone N 7. Transpgrrar 2 Company Name 8. US EPA ID Number E. State Trartsporter's ID IjLa I V F Transporter'*Phone-p ID V 9. Designated Facility Name and Site Address 10: US EPA ID Number e'>F d D 1 K-EMIRONMIFNTAL Z H. Facility's Phone Q£AS'f SnI SnI M 010 0 109 4, CA 9=3b B 0 6 18 11 12 Containers 13 Total 14 Unit 11 US DOT Description[including Proper Shipping Name,Hazard Class,and ID Number) No TYEe Ouannly Wt/Vol (. Waste Number Z a. State i t- NON RCRA HAZARDOUS WASTE.SWD{ABSOi313EWS MTN DILSI 1.) EPA/Other " 3G _ ! o EN b. m 8 EPA/Other Y "� OT a, Slate -... cc R r s EPA/Other Fd state V EPA/Olher W u --� h J AddNiain! eserlpl�ons or Materials listed Above w ! K Handfrn ,for Wastes Listed Above 11A ..x0ADD STATE 1000 :223 P �1E °°340A ~�°" Uj ad It 0 l5r$poc 1 Hardline instructions and Additional 1h formation j Z USF PPI~ EMERGENCY CONTACT'CHEITRFC 1-8I6 42 W NAEROM 11A. 171 SITE, 3940 N.TRACY I;LVD.,TRACY,CA M376 _ 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described aboveby proper shipping name and are classified,packed, Vmarked,and labeled,and are in all respects in proper condition for ironsport by highway according to applicable Intemotional and natiossaS gavernment rsjvioli—I -�+ If I am a large quonsily generator,I certify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have dotormined to be economically d practicable and shot Iva selected the rocticablo mothod oly troatment,storage,or disposal currently available to me which minimizes tho prosont and future threat to human health `rs and die environmenC OR,if I am a small quantity generator,I have made a good faith effort to minimizo my waste generation and select the best waste tganagomenk method that is 0 available to me and that I can afford, _ �. Printed d Name, Sign Month Day Yea L3 ra 14 , W R 17 Transporter 1 Acknowlod amt it o Raaa! t of Materials ee A Printed/T d Nairn Signature �n��ete{�j nlh Do Ca i N {¢ ' rp ii fel Us W 5 ,,, W is p 18 Troi anter Z Acknowled emenr o Recti r of Materiels �. ..M(,...�. ...PwLed L..,.........._,..�...�d®.�.,..®....n.....n.�.. . L`C �p • 0 E Printed/Typed Name Signaturo� T[5 UK Day Yaot N R a 1roi�1■s , 'j(G' 19. Dtscrgppncy indication Spacp Z A -- WAS��SRRS CNIOS6101 1 1 20 Pacillty Owner or Operator Certification of receipt of hazordovs motorlal*covered by this mantfpst oxccpt as noted in item 19 T Printed/Typed Name Signature , Month Day Year j .,r r ,� Y JBGI� �er'7 DO NOT WRITE BELOW THIS LINE. ',Hit, COPY TO GENERATOR'WITHIN 30 DAYS bTSC 8022A{1/991 ;:::r0: .'Ir.: <u6.:m t Lc+rai,daus WW40 For fromport cut-of••sc.rs•. EPA 8700-22 :rJ..z y of Ib.. -spy prid sorid to 075C within S(i day<)