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State of California—Environmental Protection Agency <br /> Form Approved OMB No.205",03P(Ex*es 9?�A0-99) See Instructions on back ofwe 6. Department of Toxic Substances,Control <br /> ,Please print or type. Form desigi ed for usb on ef[je(12-pitc iter. Sacramento,California <br /> UNIFORM HAZARDOUS US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> is not required by Federal law.WASTE MANIFEST 7neratair's <br /> L 0 O 1 6 0 4 4 of 1 <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number l' <br /> tI USD orf MAINiTENANCE & OPERAT. pNS 2 3 6 0 1 <br /> O 1. 05 I.E. n. STREET, WDI, CA 95240 B. State Generator's ID <br /> L ,# <br /> LO A. Generator's Phone ( ,r, ] 331 'I <br /> t� <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> LO <br /> CPQ <br /> "3OS ENVIRONMENTAL SERVICES t• D. Transporter's Phone (.916) 311-5747 <br /> 1 —574/ <br /> s, <br /> 13 <br /> oD 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] ( / <br /> F.'Transporter's Phone <br /> U 9. esi n f F cili Name and it Add s 10. US EPA ID Number G. State Facility's ID <br /> oQ A s0 ,e RrdOVER1111111111111 <br /> CDz 3150 E. PICO BLVD., LOS ANGELES, CA 90023-3683 H. Facility's Phone <br /> f)o P P P P 2 15 p P 15 (800) 499-7145 <br /> %AwQ 12. Containers 13. Total 14. Unit <br /> o11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number( <br /> U No. Type Quantity Wt/Vol I. Waste Number <br /> = aci'WASTE PAINT` RELATE MATERIALS, 3, UN1263, TII State 331 <br /> 3 D o EPA/Other IG <br /> ERG '00 f128 <br /> .i Ey 6 State <br /> N00 <br /> oo E EPA/Other <br /> R <br /> Q A o. <br /> O T State <br /> w O EPA/Other <br /> R <br /> LU d. <br /> State <br /> VEPA/Other <br /> w <br /> V) J. Additional Descriptions for Materials listed Above K.Handling Codes for Wastes Listed Above <br /> Uj <br /> C. d. <br /> Z 15. Special Handling Instructions and Additional Information <br /> HANDLERS TO BE TRAINED AND USE PPE. <br /> Z 24HR DERGENCY CONTAC'I's 916—'371-5747 <br /> UJI <br /> '7- 31 N. PACIFIC AVENUE. LODI, CA 95242 5/v"'I' .ttW <br /> 16. GENERATOR's CERTIFICATION: I herebydeclare that the contents of this consignment are full and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respcts in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generotor,I certify that l have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> practicable and that 1 have selected the racticable method of treatment,.storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> rn p <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> OPri ed/T a Na Sign re /Month Day (Year <br /> Z <br /> W T 17. Transporter 1 Acknowled emenf of Receipt of Materials <br /> 0R Month Day Year <br /> W II Pri ed/Typed Na Signature <br /> W , <br /> si 0 18. Trans orter 2 Acknowled emenf of Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> W E <br /> rn R <br /> U19. Discrepancy Indication Space <br /> Z <br /> IF <br /> A <br /> C <br /> I <br /> L <br /> f 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />