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asnagoste(eW . . T� <br /> ssaad""P <br /> vT 3 9 2036 <br /> ENVIRONMEN SAL HEALTH <br /> PCR�IiITf� Form Approved.OMB No.2050-0039 <br /> 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> 71 <br /> o .-,namng Address Generator's Site Address(if different than mailing address) <br /> , <br /> QUICK N F-A S;;Y t TART <br /> 7,OCKTON,CA. <br /> Generator's Phone 511?-344,4t' <br /> 6.Transporter 1 Company Name `• U.S.EPA ID Number <br /> t�AMO:S EMY9PON,IfHTAL VEP ICe-3 INC. CADOU4i1p33as6 <br /> 7.Transporter 2 Company Name <br /> iU.S.EPA ID Number <br /> — TVGw.a <br /> 8.Designated Facility Name and Site Address P,yCIFIC RESOURCE RECOVER r U.S.EPA ID Number* a <br /> �l tl EAST PICC t+i� iU <br /> t . <br /> C <br /> O APIGELES, A W23 <br /> Facility's Phone: 99 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) Nd. Type Quantity Wt.Nol. <br /> 1• UNI2Ci3,1+ ,ESTE CIA(SOLINE,.3,RGII r <br /> O j <br /> �. t.. <br /> Z 2. <br /> w <br /> 3. <br /> i <br /> I 4. <br /> 14 Special Handling Instructions and Additional Information XJ d /{ I <br /> F€ IiX1 ��70 t ✓ <br /> E,R. COWRACTOR; PAM EW'diiOWMENThu_ <br /> HAMMERS 31-0JLD BE TPAINED AND U-SE.APPROVE-D PPE <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:;I herbby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generato s/Offeror's Pnnted/Typed Name Signature Day <br /> �� Month <br /> - i�i�:�.�- ._c, atm �;�. ,`L•' 4 J"`i'I � �� '?� - •y. ��.I`^(r>�.. <br /> —j 16.International Shipments <br /> - <br /> ❑Import to U.S. J ❑Export from-U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of rials <br /> � Transporter 1 Printed/Typed Name � L � Signature �I� Month �y Year <br /> 16 <br /> IL <br /> Z Transporter 2 PdnteclT yped Name !, Signature Month Day year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 2• 3• 4. <br /> Hol <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted 8a <br /> Printed(fyped NameA l tn ri Vo 60 <br /> Signature Month Day Year <br /> FPA Form 8700-22(Rev.3-05) Previous editions are obsolete. nFCI(;NATFn FACILITY TO GENERATOR <br />