Laserfiche WebLink
� g g <br /> •Please print or type.(Form designed for use on elite(12-pitch) pewriter.) + Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator IDNumber 2.Page 1 of 1 3.Emergency Response Phone4.Manifest Tracking Number <br /> WASTE MANIFEST I CAL.0OO;5jrd/ 993 „r 371.1,7,1_ 791323 JJK <br /> 5. eneatoe.s ame and Mailing Address " '• , Generators Site Address(if different than mailing address) <br /> Couij;;;/A?0wkET p�,oes naa sA�t �afEeP�:s�� <br /> /78q w. CHrwc+z-P, way <br /> 5+t>Ck*^),e-4. gsacd& <br /> GeneTators.Phorr yo$ 1.63-65,/y <br /> 6.Transporter 1 Company Name _ U.S.EPA 10 Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address pA,CIFIC RESOURCE REDO'/ER', U.S.EPA IDNumber r <br /> 3f Yi EAST PICO 191-\213. <br /> LOS ANGELES,CA ^,OO;:d 6 A D00"& HoS <br /> Facilitys Phone: 300-499-1,45 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(A any)) No. Type Quantity WtNol. 13.Waste Codes <br /> t~rJI S, WA5 FCRmmA4Gc'So4D� eJ�lJY}�i�. a IB <br /> o N.o•5 y,/,lk rrr LGAsaG�wDc, lic-0c:s) C}CJ i 0.1a isa <br /> w <br /> w 2 IApi WR GiA4oC:.x Icy 3, ?Z <br /> pp i OM 30 �i `�� QatDota <br /> 3. <br /> -�r{ i <br /> 4 • �;L <br /> 4. <br /> MAY 202016 <br /> 14 Special Handling InsWctions,and AddNonal intornation.._ s. I`11 y,• .JQ <br /> N011*3 TC1 8 TiWNC1 :;E APPFrr:EO PPF. <br /> 9 8� IO ,ACTORr RAMOSD ARONNMENTAL ERACEES ' <br /> FAV RIC �Xis <br /> 15. GENERATOWSIOFFEROWS CER71MCATION: 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 Iabeledlplaanded,and are in all aspects in proper condition for transport according to applicable intemabonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknawledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(HI am a smell quantity generator)is true. <br /> Generators/Offerors Pdntedrryped Name Sgnatua Month Day Year <br /> ti I "A jjG <br /> J 16.International Shipments <br /> i ❑Import to U.S. ❑Export from U.S. Portof entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> K Transporter 1 Printed/Ryped Name / Signature -_=_yam\ Month Day Year <br /> I 0V 142 ii, Ile <br /> aI ransporter 2 PrimmIyped Nave r Signature Month Dax Year <br /> t18.Discrepan y <br /> 18a.Discrepancy Indication Space <br /> F-1 Quantity ❑Type ❑Residue ❑Partial Rejection ❑WII Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Faalityk Phone: <br /> W 18c.Signature of Ahemate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C3 1. 2. <br /> I <br /> 1 20.Designated Facility Owner a Operator:CeNficaeon of receipt of hazardous materials covered by the man"desl except as noted in Item I Be ' <br /> PrintedRyped Name Signature _ Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />