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Please pdril or We. Form doslgned for use on elite 12•plteb)typewriter. F.orniApproved OMB No.2050-0039 <br /> UNIFOW WAZARDOUS 1.Generals IO bei Page I o1 3.Ernergeacy Response Phone 4.Manifese TrackingNumber <br /> WA&TE MANIFEST C A L �'"nb 0 1 8 2 6 a s (aoo� a.9�aa. Q O 9 5 6 3 2 3 J1J K <br /> 5.Gene� l�r�� 'tai' dress GenwatolsSileMdrrlss(ddNfetantthanmaftaddress) <br /> 600 E.KETTLEWN RD. <br /> LODI 209 339 0900 CA 96240 <br /> Generators Phone: <br /> e.Transpoder 1 Company Name U.S,EPAID Nvmbef: <br /> ASBURY ENVIRONMENTAL SERVIOES F C A p 0 Z g 2 7 7 0 3 6 <br /> A <br /> 7.Tlansparter 2 Company Name U.S.EPA 10 Number <br /> 8.Dwlgpgiled Ea�fyAama and Site Address U.S.EPA LD Number <br /> 7730CHEVRONWAY CA HEALTH C A T 0 9 0 0 1 2 6 0 2 <br /> fade a Phone: (70716'93 d00f3 p "� Yk a f-P.f T <br /> 93. 9b.U.S.DOT Desc4ft(utdudirg Proper ShWjV Name,Hazard Class.ID Number, 10.Contakers 11.Total 12.Unit 13,Waste Codes <br /> N61 and Paddng Group(d any)) No. Type Quanuy WINol <br /> 1. 223 <br /> o NON-RCRA HAZARDOUS WASTE, LIQUID(OILY WATER) 001 T,T � G <br /> z 2. <br /> w — <br /> 3. <br /> 4. <br /> 14,Spedal Haate�sg InshtKttorts and Addiid—I lnfamaGon <br /> NAER04 9131 : 171 'PRORLE#9B1 :DK110442'ENERGENCY CONTACT:CHEMMEG 1-800-42dADDITIONAL EPA <br /> CODES:981 :,NONE'APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SIOFF EROR'S CERTIFICATION: I herehydedare that the contents of Ws cons.V M1 aro fully and aocurately dew W above by the proper shfpphtp name,and are dass 4d,Packaged, <br /> marked and labeWtp!acanded,and aro to es respects to proper cgndtion fooamport aasding to appawbto Intemat)onaland national governmental M11111atlons.116W sNprllentaad'.am the Primary <br /> Exporter,I Certify 0131 1110 Wntents of this oonslgnrn"f conform to No terms of the attached EPAAcivw 1edgmenl of Consent. <br /> I oovy that the waste rt'�n'mlzalion statement identiEed to 40 CFR 2b2.27(a)(d I am a terga quantity 9800101)Of(b)(dl am a smaA gtuurlily generate)is iota. "U, gay Year <br /> 4"n et slr)fferoea Pdntlb <br /> ed/Typed Nam@ lye <br /> ..r 18.interna' Potents El Impod to U.S. ❑Exm from U.S. Pal of entrf"wit <br /> Transporter s'gnalure((or exports ON# Dale lea*q U.S.: <br /> F V.Transporter Ackrw.%Wgmenl of Rece_w of MSlgnahrre hianUt Day Year <br /> aterial ` <br /> y Transporter 1 Printocyped Name . <br /> a <br /> 1d nS O 14t Day Year <br /> Transpoder 2 Pdntedlfyped Name Signlatut0 <br /> 18.DWepancy <br /> 18a.Disuepancy Indkation Space QtJanGly Q Type ❑Residue P.W R*cd- ❑AA Re,eotloo <br /> Manliest Roference Number. <br /> fBb.AllemateFaa7iy(aGenerata) U.S.EPA ID Number <br /> v <br /> I Farxl a Plane: 1 Day Year <br /> w tec.slgnaNreofAltemateTaijE (aGensrata) <br /> z <br /> 1g.Hazerdova v/aste Repod hianagemant Method Codes(1.e.,codes for hazardous waste and recycling sys!ems) <br /> 4 <br /> L <br /> 20.Deslgnaled FaoiLty Conn a Operator:Certification of receiPt of hazardous materials covered by the manifest except es nded In Item 18a IAonth <br /> Prnted/f ams Ssjnaruro <br /> l 00 <br /> EPA Form8700.22(Rev.3. 5) PfevfOU eedi0onsareobsotete. n1=c1r. 1 1 VAI' Irvin nF�TlNI171�fJ STATE((F REOHIREDI <br />