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type.( 9 ie (12-pitch)typewrite 1 Form Approved.OMB No.2060-0039 <br /> ~Pjease print or Form designed far u on eliter Phone 4.Maniteat Tracking Number <br /> NIFORM HAZARDOUS I.Generales ID Number 2.Page 1101' 3.F-mar9ency Response _ JJ <br /> WASTE MANIFEST fAfiOl!Cg12rb54' i -BPAn-41493N0 <br /> 5.Generators Name and Malrg Address Gerrerators Site Address(if dhfereM Nen maileg address) <br /> INTERSTATE TRUCK CENTER <br /> 641 S HARRISION STREET <br /> STOCKTON, CA 95206 <br /> Geeerarers Phme: 246!-35151. <br /> US.FPAID Number <br /> 6.Trenspwler 7 Company Nemo C aR00ri)1948:3 7 <br /> PACIFIC COAST LACD1JtR <br /> 7.Tramporler 2 Company Name U.S.EPA <br /> ID Number <br /> 8.Designated Fadby Name and Re Address U.S.EPAIO Numpw <br /> PACIFIC RESOURCE RECOVERY CAD06E1.2524_0ti__ <br /> `i 50 LAST"PILL) BLA). <br /> I.OS ANGELES. CA 90023 <br /> Fact 'a phase: 800 499--7145 <br /> Op.U.S.DOT DeNrgeon(intlud4q PIDW Shipping Name,HM(d Cleae.M Number, 1D.Conlamers 11.Total Q.Umt 13.Wade Codes <br /> HM and Psckb4G=P(fmY)) Quantity WCNPI. <br /> N0. Type <br /> 7. +UN1263, WASI'C- PAINT RELATED MATERIAL, 3, 0001 G:03 005 <br /> 0 PGII, Fig, (0001) pin ,� 1; 214 <br /> z 2 <br /> W <br /> ON <br /> 3. <br /> 4. <br /> 14.Special Homdri g Instructions and Additional In tion <br /> _ ._. .. . <br /> GLOVES, GOGGLES & PROTECTIVE CLOTTING <br /> ERG#: 9b1 ) 128-rfl'.riit"NeME' <br /> TRANSPORTER 1 PHONE # 1-807-75 ?": '• <br /> 15. GENERATOR370FFERMS CERTIFICATION:1 hereby passive met me contents of Nis consignment are W1IY and acmratety described above W the Props shipping name,and are classified,packaged. <br /> marked and lahetedlplaurded.and are in all respects in proper condition for NansMn according to applicable international and national g menN1 regulatiors,it export shipment and I am the Primary <br /> F_xpwler,I carry that the coram s of this consignment conform W the banns of the attached EPAAckwMedgn'ent of C4n5en <br /> 1 certify thm me waste mnimiation statement identified in 40 CFR 282.27(a)(8I am a large quantity 9eneralw)w(b)(al smhi nary generator)is We. Month Day Year <br /> erVs Pdnwffyped 19 <br /> i <br /> f17 <br /> tbnd R Is ❑InporlMUS. ❑Export mU.s. Pad of etrylexit <br /> Dale having U.S.: <br /> orter sgnature(fwexpwtsonlyt <br /> isWWAcim wled9mentof Reoeptof Metards f Year <br /> ftr mte0yped Name �- <br /> r <br /> r \ Moom Day Year <br /> l 2 nn�dlFYped Name G <br /> <P5 <br /> ._ 18.Discrepancy I-'T <br /> I�I� ,__._tJPamatRels12ron __ . ____. ❑Putt Re(eNwr-._. <br /> 11M.D65[teParwY lnNcatlon.SPase--_-Q � �Reshma.._-..—. <br /> Manifest Reference Number. <br /> U.S.EPAID Number <br /> 18b.Altwnate Fa mty(or Gerardbr) <br /> J <br /> U <br /> LL Fad(iys Plwne: Month Day Year <br /> 0at8e.Signature ofNtemate Facility(w Generates) <br /> y19.Hamdous Waste Repot Managemant Method Codas(I e..mdas for hazardous waste beabnem,disposal,and recycling systarrm) <br /> 1' 2. 9. 4, <br /> 20,peslgna[ed F,HIW Ptyan &Operator:CerbSptbn of receipt of hacardous melenals covered by the mandout exwpt as nded n Item Itis - - Mmm Day Year <br /> 1 n yp16 Name SignaNre , <br /> EPA Form -22#A) Previous 11-dkns•areobsolele.• DESIGNATE . FACILITY TO GENERATOR <br />