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.3237800078 PACIFIC RESOURCE R 03:11:54 p.m. 08-10-2006 212 <br /> Slam of California—Environmental PsRIaction AVA"y <br /> Farm Approve, b No.2050-00391Eepires 9-30-99 See Instructions on back of 06. Department of Toxic Substances Cannot <br /> me. <br /> PlsF. Form designed fbr u�an PllpfFl pbch)ot.. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Ge orame.US EPA ID No. Manifest Doc.mem No. 2. Page 1 1 Information in the shaded arms <br /> G A R 0 0 0 112 1015 4 3 6 5 8 6 1 1 1 is not required by Federal law. <br /> WASTE MANIFEST Per of <br /> 3. Generators Nome and;Moill gAddrm. Ilea Daia nnnl Number - <br /> TNTERS�ATE TRUCK CENTER <br /> 641 S HARRISLUM STREET2o4r <br /> c SSTOCKTON. CA 96206 e. slat.G.aeratere lD° <br /> vi <br /> A. Generator.Phone(2439 )467-3661 <br /> n <br /> 5. Transporter I Company Nem. 6. US EPA ID Number C. Sots Transporler's ID Ilted,l <br /> c PACIFIC COAST LACQUER C A D 0 0 8 2 5 2 4 0 6 D. TmmpwNr,Phan <br /> vir 0 <br /> 7. Tran.paner 2 Company Name S. US EPA ID Number E. State Ttumporro,.ID IRererv.d.) _ a <br /> F. TraPpjortes' �PsMhots ,. <br /> PQet <br /> A "I! F00tM&51 ERY `.'10. US EPA ID Numb. G' E�E SO <br /> 3160 EAST PICO BLVD. <br /> LOS ANGELES. CA 90023 C A O 0 0 8 2 6 2 4 0 6 FL fv'y <br /> b.. r; r �q� :A; .JI q�'• <br /> 11. US DOT Description(including Proper Shipping Nam.,Hazard Class,and 10 Number) 12 Container. 13. IA. Unit 1 <br /> U No. T Quantity <br /> liy WI/Vol I. WasteNumber <br /> _z y ae e a trt elate Material. 3. UM1263, smte - 21; <br /> Y P SZ (if001) <br /> 3 G D M < e EPY/ESYy{i <br /> E7 <br /> N d ilatlpr saw .; 11 <br /> LId <br /> ..�. <br /> E <br /> R <br /> a, A <br /> 6 T c' Ston <br /> i <br /> to O <br /> _ R EPA/OIiR':. <br /> oe <br /> � d. slat. <br /> zy <br /> V EPA/Oth.. (' <br /> W <br /> h J. Additional Descriptions Far Materials Listed Abpw K. handling Cd.Fur Wpstn Listed Above <br /> gz_ 1111) lacquer ThAIENker/Raint skutow ,K, eve 4 . rw b <br /> Add EP•�AA f t�uF&03, .P„04►tr v <br /> J AIt,iR•� r . a � a d. <br /> Zrl IS. Special Handling Instructions and Addilienal lnformalicm , r FIA) AP <br /> Z Gloves. Gcflee & Protective GloUiing <br /> EMERGENCY CONTACT: CHBMTREC 1-900-424•-9300 <br /> W ERGIIs 11A) 128 118) &Q@ <br /> s <br /> : 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully endamralely dmcribad.1r.., ,proper ship Ing nems and are classified,packed, <br /> QV, marked,and labeled•and aro he all respects in proper condition for transport by highway acemding to applicable intimations(and naliono goveromenl regulmiom. <br /> IF I ons a large qmm iy generator,I cermtify that I have a preyram in place to reduce the volume and laitkity,of wash generated m the degree I have determined to be sconoml<alb <br /> N, practicable and IAat I hhave sel.ted the praclimble method of treatment,storage,or disposal currently available to me which minimizes the ppre.em and future threat to human hwllh <br /> t>: and the environment;OR,If I am o sall n <br /> qunnrity geeraler;I have made a good faitl,.effort W mQlmi� <br /> my waste generation and select the best waste management method that is <br /> 0 available to me and that I can 66d. <br /> VPrnpdTypad Nams ^,..,s Ig tun /„• t ' Month Day Ywr <br /> z. r” I e <br /> W <br /> rU ; 17. vans orMi 1 Acknowl emenl e{Recsi 1 of MaUriab <br /> WORMY. y+r / / / Month Day Yearw- .;w/ �^ ,✓'�..� 'f1 r°l,I t r°�l�✓ rf 1' /J.,.- ,it // 71,'; J <br /> LL 0 16. Trane rNr 2 Ack."Iod ement of Recsi t of Materiah <br /> IPrinted/Typed Nam. Signature Monla Day Year <br /> Q R r <br /> L 19. Discrepancy Indication Space <br /> Z. R n. <br /> C <br /> L <br /> I 20. FaciliN Owner or Operator Codification of receipt of hazardous materials c ed b thi. anifest encs t eT6f"ediriltem 9. <br /> T rinlsd/typed Nome Signature Month Day Ywr <br /> Y / <br /> DO NOT RRE BELOW T INE. _ <br /> !TSC 8022A 11/991 White: TSDF RETAINS <br /> EPA$700--22 <br />