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03=04-'15 15:48 FROM- oles Environmental 661-322-88io T-454 P0001/0012 F-956 <br /> Please print at type.(Form designed for use on elito(12-pitch)typewd(ec) Form Approved.OMB No.2050.OD39 <br /> UNIFORM HAZARDOUS 1,GeneialorlD Number 2.Pape tot 3.Emergency Response Phone 4.14anifesl Trach hg Number <br /> WASTE MANIFEST CAL00055877 1 209-4613-0450 0134352.62 JJ K <br /> 5.Generate re Name end MaltngAddreas Generatofs 9ifaAddr"(if difforenl shah madingadd(ess) <br /> PACIFIC SOUTHWEST IRRIGATION <br /> 8372 S.JACKTON RD. <br /> STOCIS'r17N,CA 95215 <br /> Generators Phone: <br /> 6.Tmnspaderl Company Name W.3,'PAID Number <br /> George W.Lowry,Inc. CAPM0949019 <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> APR 0 8 20'5 <br /> B.Desi ae I N it d aso U.S.EFAIDNumber <br /> 1610 W1��ttreet n991uc' ENVIRONMENT-A CAD.2SM122 <br /> 1610 W Y7t0Street - <br /> LONG BEACH,CA 90813 NSA' "^�On "e <br /> FacalNs Phone: 806827-6729 <br /> Its. 0b.U.S.DOT Description(indadtlg PtoperSNpping Name,Hazard Class,ID Number, 10,Containers 11,761al 12.Unit 13.Waste Codes <br /> HM and PaN,drtg Gmup FfffiY)) No. Type Quantity WIJVeL <br /> sz X 1' UN 1593 WASTE FLAMIMBLE LIQUID n. o,6. (Abet rlE) 3 PG71 DM G2 DD01 <br /> w 2. <br /> 3. <br /> 4. <br /> i 14.Special Handling lnswcgone andAdNgnnal lnfomation - <br /> ERG%128 Acetone PVC plpe.pdmer PRDFILEir' ��, IR[VOICETi 2S-036 , <br /> USE GLOVES <br /> 15. GENERATOR'SIOFFEROR'SOERTIFICATION:Ihereleydeelare lhaltlteconlenlsolmis consignment are fullyand accurately,dascn3edahove bythe propershipping name,erd are classtded,packaged, <br /> marked and labeled/pfarceded.3ndam N an foEpeds In lempercondidon for tampon according WappucaHetnlemallonslend naSohelgovemmehfalregula ons.IfelponsNpmenland l am the ledmary <br /> Exporter I ceNy that the contents of this consignment cohform to the ferns ofthe attached EPAAcknmvladgmanlof Consent. <br /> 1 cadiy,Ihm the waste mitdmizegon slatement(den6ged in 4d CER 262,21(a)(If l am a large quanlirygene alol)or(b)(III am a amen quamuygeneralar)to lme. <br /> Generdm/s/00e olrPdnledMpad Name Signature Month Day Year <br /> -� 16.International SNpmebtb .. <br /> F_ ❑Impad to U.S. ❑Export from U.S. Portofenbylodl: <br /> K 1lansporler slgnalute(for exportAonlyf: Dare leaving U.S.; - <br /> Of 17.TranspodarAdneWedgmentofRecelpl Of Materials <br /> a Tramponer l Pdnle Name Signature Month Day Year <br /> rrtq <br /> dTramporer2PAIWlyped Name Signal= Month Day Year <br /> F <br /> 18.Oiecepency <br /> lee.Discrepancy Indication Specs ❑ ausocy, ❑Type ❑Residue ❑Penial Re)edioh ❑Full Rcjcction <br /> Manifest Relarenco Number. <br /> 1Bb.Ahemate Farntiry(or Generator) U.S.EPA-10 Number <br /> J <br /> U <br /> k Peow Phan': <br /> u� 181 Signature olAllemele Facifly(or Generstot) month Day Year <br /> 4 <br /> 2 <br /> 19.Hazardous Weslo.Report Menegoment Method Codes(i.e..codes forhazardous Ylasle treatment disposal,and recycling systema) <br /> 20.Designaled Fadli"ineror Operatac Certficanan ofreceipto(hazardous maladalucoverodby1he4nilgRoeplas medias Item 18a <br /> ParkNamo N Si tort Me Year <br /> EPA Form 6700-22(Rev.3.06) Previous editions are obsolete. ATED FACILITY YO 6EStINATION STATE(IF REQUIRED) <br />