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`MAY=12-2005 13:51 FROM:TRACY T ' K & AUTO S 12098325307 :4683433 P.9 <br /> Stole of California—Environmentof Protection Agency - •See.Instructions on back of b. rtment of Toxic Substances Conlrol <br /> Form Approved OMB No.2050-0039(E;Ypires 9.30.99) J.larrua <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Sacramento'Co <br /> 1. Csoneraror s U$LPA IP No. Manifest Document No, 2, Pagel 71n�for"menn in the shaded areas <br /> UNIFORM HAZARDOUS quired by Federal law. <br /> WASTE MANIFEST Cj ® 2 2 1 1 6 1 0 7 of 1 <br /> 3. Generators Name and Mailing Address A. Swfa MoniFest Document Number <br /> TRACY TRUCK AND AUTO SHOP 21361107_ <br /> 3440 N.TRACY BLVD. B.state Genata <br /> ere s ID <br /> TRACYGA 95378 <br /> in 4. GenerrIrs Phone( 209)832-5307 y <br /> N S. Transporter 1 Company Nome b. US EPA ID Number C.'stare transporter's ID -ed-) <br /> sA <br /> a7 <br /> D. Transpoctafs Phate <br /> ® FURY ENVIRONMENTAL SERVICES C 217171 (310 <br /> epr <br /> 7. Transporter 2 Company Nome 8, US EPA ID Number E. Sfoly SriansportorslD.[Rssorve `I <br /> J Is. Transporters.pht>,ra <br /> J <br /> U 9. Designated Facility Noma and Site Address 10, US EPA ID Number Ca. Stale FacthtyelQ <br /> �I d DXENVIRONMENTAL <br /> 4 ZW 3650 E.26TH STREET h. Fat ilify'e Phone <br /> ClAlTI 61811. <br /> 12. Containers 13, Total 14, Urrit <br /> 4 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) — No. T Quant{ WI/vel 1. Waste'Num <br /> 7 a. $44,11y2 <br /> z NON•RCRA DOUS WASTE, SOLID(ABSORBENT,DIESEL) P NE&(ghof <br /> E <br /> Stale <br /> a N b' <br /> go <br /> E EPA/Olher' <br /> R <br /> v A Slet. <br /> ® 0 EPA/0116r <br /> R <br /> State <br /> °Lu d. <br /> Z EPA/Oi6l <br /> III <br /> U <br /> is <br /> J. hddltienal Descriptions For Materials Listed Above K. lfondling Codes#or Was titled Above <br /> v <br /> 4 a, b: <br /> a_ 11A) XG <br /> Lu <br /> -m <br /> a. <br /> J <br /> Q <br /> 0 15, Spatial Handling Instructions and Additional Information <br /> USE PPE EMERGENCY CONTACT:MEL HARPER <br /> Z RGO 19A 171 ` t (310 5010 <br /> Lid LA t— y <br /> Js <br /> 16. GEN R'S 6ERTitTCAT{ON: I hereby declare that the contents OF this constgnmenl aro Fully and accurately described above b1 proper ishipgng name and are classified,packed. <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway y cordirtg to applicable internationa and natonal)government regulations• <br /> If 1 pm a large quant{y generator,I certify Thal I have o program in pieta to reduce the volume and lexiciq of waste generated to the degree I have determined to be economical) <br /> practicable and that I Novo solaciad the practicable method of treatment,trorage,or disposal currently ovalkabla to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimlxo my waste generation and select the best waste monagantent method OW is <br /> available to me and that l can afford. <br /> 0 Printed/Typed Name Signature Man Day Your <br /> z <br /> �� ® 2 C) <br /> tW I 17. Irani r 1 A;knowlecl errant Of Recel t of Materials y <br /> w Bp Printad/Typed N ff a $igrmluro �, ro, an� y p�Y�r <br /> N (fit{J` t—oo— <br /> w s ` <br /> ra_ p 18. Tron rtor 2 Acknowled amens of Roca{ t of lariats Month Day Year <br /> O A Printed/Typad Nome Signature <br /> Uj E <br /> R <br /> 19 Discrepanry IndimKon Space t <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> F 20. Facility Owner or rotas Cernfieatran of receipt of hoxardous motarla13 covered b this manlFest exce os noted In Irani 19. Month Doy Year <br /> T Printad/Typ <br /> ed Notre Sienafirre <br /> v <br /> DO NOT WRITE BELOW THIS LINE. <br /> White 1SUf.S THIS COPY DISC wi30 DAYS <br /> QTSC 8022A(1/49) 1'c P O Boxx 30 3004, Sacramento, CA„ 95812812 <br /> EPA 0700-22 2- <br />