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Please print a type.(Form designed for use on elite 12-pitch .) Form Approved.OMB No.2050-003 <br /> UNIFORM HAZARDOUS1 Generator lD Number 2.Pegs 1 d 3.E.. R.%.Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 4X eW0/ 5�3 1 1-800-499-7145 007422784 J J K <br /> 5,GenearNs Name and Ma&gA0dmes Genereta's Sm Address(d dmarf dein makng address) <br /> Gal S fbg22,cSo t/ S7 <br /> STOcC7DN. �.4 9.�'dU.? <br /> GarlerabNa -....3333 <br /> 8.T7 U.S.EPA ID Number <br /> PACIFIC COAST LACQUER CAROM194837 <br /> 7.Tnreporlx2 Company Name U.S.FPA ID Number <br /> S Desgmtsd Facility Name and SheAAdrm U.S.FPA ID Number <br /> PACIFIC RESOURCE RECOVERY CADWS262406 <br /> 3150 EAST PICO BLVD. <br /> LOS ANGELES, CA 90023 <br /> Fabtlhys Phone: (800) 499-7145 <br /> 9, 9b.U.S.DOT Description(Indudmg Roper Snipping Name.Hazard Cass,ID Number, 10.Contdrrrs it.Tall 12.Unit 13.Wase Cordes <br /> HM and Paging Grcup(6")) Na. Type Qum" WLN& <br /> 1PGII, RQ, (D001) i <br /> DM 6 214 <br /> 7W 2 <br /> ca i <br /> 4. <br /> 14. H.rdN InssuCbOMam AditOrd Infanatlon <br /> 9bl) AP# 6328 <br /> GLOVES, GOGGLES S PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: KIRK WALDORF <br /> ERG#: 9bl) 128' 9b25 229-^' - <br /> TRANSPORTER 1 PHONE # 1-888-770-8152 <br /> 15. GENERATOR'SIOFFEROR'SCERTMICATRRF. I hembydedam MdtilecralMle dtlYe mneignmeM azefulty and accurately described above by tie pmpaShIppkg ram.and aedassiled,packaged, <br /> marked and lebeledlpecamed,and are in ad respects In proper condition for trrepod according to applicable international and national gwemmenel reguetiora.N export shipment and 1 am the pdmry <br /> Fvomr I m*to da concerts of this casgnm ,motion w the temp of the abdwd EPA Aaramnadgment atCo Peart. <br /> I On*the,the wade mngn cab n sdrnam identified in 40 CFR 262.27(x)(d I am a ww qwt y geramtor)or(b)(it m a small quand rieretorJ One. <br /> bfd0lferafs Rinted/fyped Name Si Nm Mrm D Year <br /> 18. ts ❑Impodb U.S. El fern U.S. Pat d entrylent _. <br /> = Transpodr signaWre(for worse only): Date le"U.S.: <br /> 17.TransprbPdmmNadgnlenl of Recapt of Materials <br /> S <br /> QTransporter 2 PmyWgFyW Name Mantic Day Yer <br /> K <br /> r <br /> } 18.D'aaeprwy <br /> 18a.Disuepancy Indication Space ❑ Duanuty Tyx ❑RIA. Elprod Rajende. ❑FUY Rapctm <br /> Manifest Reference Number: <br /> 18b.Marinate Facility(or Generator) U.S.EPA ID NwNw <br /> J <br /> U <br /> LL Fadhys PFane: <br /> w 1S,Sigretum dAlremae Faddy(a Generator) Month Day Year <br /> r- <br /> Z <br /> y19.Hazardous Wade Report Managament Medxrd Codes(i.e.,mdas for h®Nous waste Immanent,disposal,and reuydag system) <br /> w3. a- <br /> o ' <br /> M.Desawted Facility Owren Opembr Cediacadon of mratpt Of hazardous m eemis mvrad M the meifeat exaplae noted!in hem 18s <br /> PdnisdfryDed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.305) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />