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03-04-'15 15:48 FROM- s Environmental 661-322-8883 T-454 P0001/0012 F-956 <br /> Please print or type.(Form designed for use on elite(12•piloh)typewdler.) Form Approved.OMB No.2050.OD39 <br /> UNIFORM HAZARDOUS 1,Generator It) <br /> Number 2.Pagetol 3.Emergency Response Phone 4.Manifest TracgeO Number <br /> r; <br /> WASTE MANIFEST ' W&77 2094W.DM 10134352.62 JJK <br /> 5.Generator's Name and MaltngAddmss Genembo(sSileAddress(f different Nan marling address) <br /> PACIFIC SOUTHWEST IRRIGATION <br /> 8372 S.JACItTON RD. <br /> STOCIMM.CA 95215 <br /> Generators Phone: ' <br /> 6.Tmnsporter l Company Name U.S.EPA ID Number <br /> George W. Lowry,Ino. CAR MM47012 <br /> 7.Transporter 2 Company Name 8 n15 U.S.EPAIDNumber <br /> 6.Desi a e N g dress .S.EPAID Number <br /> 11610 W 17tR�reel c. HEATH OEPARTMENTCA=.>ae <br /> MU" <br /> LONG BEACH,CA 90813 <br /> Faceltv's Phone: 800-827-6729 <br /> 9e 9b.U.S.DOT(lescriplion(indudsrg PropwShIpping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Ung t3.Waste Codas <br /> HM and Paddng Group Vary)) No. Type Quantty WINOI. <br /> X 1' UN 1993 WASTE FLAMIv1A8LE LIQUID n. o.5. (Acetone) 3 PGII I DM n G33 2 DODI <br /> g1) C/7 <br /> w 2' <br /> Ii-- <br /> 3. <br /> 4. <br /> 14,Special Handling Irwauctions andAddltionel information n <br /> ERG#128 Acetone PVC plpe.pf it er PROFILE# <br /> USE GLOVES <br /> 15. GENERATOR'SIOFFERDR'SOERTIFICATION:Iherebydedere that The conleAlsofgds constgnment are fullyand accurately described above by the proparshipping name,aid are class7ed,padrageG, <br /> marded and la6elwilplacarded,4and am In all(aspects In proper condition for 0anspon according to applicable inlemationsland national go mmmenlal regulations.IfexponshIpmenland l am the Primary <br /> Exporter,l curtly that the contents of this consignment whfnma to the terms of the attached EPAAcknolvtsdgmenlof Consent. <br /> I eertifythat as waste mininekatian statement denfigad in 46 C15 262.21(x)(If I am a large quantity generator)or (if I am a ame6 quantitygenenebr)is(me. <br /> GaflaardlOtte ors Pdnled/ryped No 8(gnslae Month Day Year <br /> I ( is- <br /> 16.International Shipm ❑ <br /> olds .. <br /> F— ❑Impart to U.S. Exportffom U.S. Podofenlrylexil: <br /> 1Tansponers1gnalute((oreyyodafonW: Dale leaving U.S.: <br /> w 17.TanspaderAdmowledgmentofRecelpl ofMalwiss <br /> Transporter 1 Pnnlsgrp Name Signature Mona Day Year <br /> n� C C- lt%t off. T <br /> Tampoder Z Pdnled/fyped Name Signal= Mona Day Year <br /> ta.Discrepancy <br /> 19e.Disdepancy Indication Space ❑ Quantity ❑Typo ❑Residue ❑Penial Relecien El Fell RsJedion <br /> Manifest Reference Number: <br /> lab,Nlemala Famtfry(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> tai Faalitys Phone: <br /> 18s.Signature ofAllamele Facility(orGeneeter) Mona Day Year <br /> Q <br /> 19.Hazardous Wada Report Manegament Method Codes(i.e.,codes for haeardo6a yraele ueavnen4 disposal,and moycling systema) <br /> 2. S. d. <br /> 20.Designated FadlityOvmer or Operator.CeNhcafbn of receipt of hazardous meladals covered by as 4nI(qNcepI as noted in Ilwn l6a <br /> yIf Pnnle Name Si ler o Yaar <br /> EPA Form 6700-22(Rev.8-06) Previous editions are obsolete. ATEDFACILITYYO 6ESTINATION STATE(IF REQUIRED) <br />