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Please print or type (Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 UNIFORM HA7ARDOUS 1,Generator ID Number 2 F''age 1 of 3.Emergency ResNnse Phone 4.Manifest Tracking Number WASTE MANIFEST G r L O O O l fl 2 f 9 `r 1 (800) d-14-9300 014 6 12517 JJK 5 Generatys Nano,and Mail ng$2322 Address JIFFY LUPE Genornto?s Site Address(l different Irian mailing address) 500 E, FETTLEMAN RD, LODI CA G5290 Generators Phone: 0 q 0 9 0 0 6 Transporter 1 Company Name U.S.EPA ID Number --.� 41.1ti tiJVI:',�-`1`}•:r�i'+TA i ? r!�'_ _r Z 2 y+ rl 9 D 7fl r 7 Transporter 2 Company Name U.S EPA ID Number B.Designated Facilq Name and Site Address U.S.EPA ID Number DK DIXON 7300 CHEVRON WAY DIYCIN CA 95r`320 Facility's Phone, (707) 693-6006 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Cass,ID Nrmbor, 10.Containers 11.Total 12.Unit HM and Packing Group(d any)) 13.Waste Codes No. Tvpe Quantity WVVoI. 1 o NON-RCRA HAZARDOUS VASTE, LIQUID (OILY WATER) 0 0 1 T T G 21 w I z w r a I I I 14.Special Handling Instnxtons and Additional Information ;IAERG# 9R1 . 1-11 t PROFILE $ 3E1 DF:110442 *EMERGENCY r--DNThCT: CMEMTPEC 1-800-4 2-4- 300 } ADI-ITI01gRL EF2A CODES , 9P•1 r NCINE + JK?PP.OPP,IATE PEP.SONJm L PP,0TECT1'v EQUIPMENT � p yx 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are it all respects in proper conrtfion for transport according to applicable mI atonal and national governmental regulations.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowleedgm nl f Consent I certify that the waste minimization statement identified in 40 CFR 26227(a)(A I am a large quantity generato or( (if I am a . all qu tty ge is I ff-la W-YOfterVs PrinledrTyped m ` Signatu Month Day Yea: 1�4V Ctl�� rl V 16 internationalShpmenls ZEl Import to U.S. L VJ F_)port from U.S. Port of en\vkvx _ Transporter signature(tor expos;only;: Data leaving U.S.: LU 17.Transporter Acknokledgment of Receipt of Materials l a er t P me Name I Slgnatrre 21, Day /Year o D d� 6 CL U) Z ransporter 2 Pnnted[typed Name Signature ions Day Year d 1 B.Discrepancy rr � 1 Ba.Discrepancy Indication Space t] Quantity ❑Type ❑Residue 1-1PartialRe}ecbon a Full Rejection Manifest Reference Number. 1 Bb.Atlemate Facility(or Generator) U.S.EPA ID Number J v Facilitys Phone: W 18c Signature of Afternate Facility(or Genemtor) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,cedes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the maniiest except as ncted in Ithm 18a Pnntod/Typed Name Signature Month Y Cc CR.1c C\ J7 f/ EPA Form 8700-22(Rev 3-05) 15-mviouidditiens are obsolete. DESIGNATED FACIbfY TO DESTINATION STATE (IF REQUIRED)