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<br />Form Appmed. OMB No. 2050-0039
<br />EPA Ford870M (Rev, 3-06) Previous e0fons are obsolete, `-- dIGNATED FA&L—ITY TO DESTINATION 4TATE (IF REQUIRED:
<br />� - I- I
<br />UNIFORM HAZAjR DOUS 1, a1 10 Number Emergency Res Tracking Number
<br />CAL000251953 2 (800) 326-1011 001368115 JJK
<br />WASn MANIFEST
<br />6. GmwaWs Nam and Wrig Ad*m
<br />B A C Painting Solutions
<br />107 Val Dervin Pk"
<br />Stockton, CA 95206
<br />Geriemioesphone.. 209-982-0422
<br />6, Trmwpoft 1 Company Name US, EPAI
<br />General Envirormental Mgmt !no. CAD983649880
<br />T —Tmovomf 2"i Company Now U.S, E P AII)Nuftbor
<br />8. Name- U.S. EPAID Number
<br />&;j1A1
<br />ldf-
<br />I , cyva, ZW
<br />11855 White Rock Road
<br />Rancho cordg?t,,Rh,j,5J42
<br />Fadll es Phone: CAD900884183
<br />ga 9b. U.S. DOT Description (Including Proper Shipping Name. Hazard Clan, 10 Number, 10 f 11. TOW 12. Ura 13, W" Codes
<br />HM and Pack1ngftup(ffany)) No. 'rype, Gmtky 1AAA
<br />1-RO, Waste Paint related material, 3,
<br />Am
<br />-4fil- _rm
<br />UN1263, II (toluene, xylene)(DO01) 0 1 q00 P
<br />FOOS
<br />Am—
<br />Fu
<br />x
<br />2 -RQ, Waste Disodium trioxosilicate, 8,
<br />141
<br />D002
<br />UX3253, III (DO02)
<br />DF
<br />200
<br />P
<br />X
<br />3. Waste Sodium hydroxide solution, 8,
<br />141
<br />D002
<br />UX1824, 111
<br />0 1
<br />Non-RCRA hazardous waste liquid (Water
<br />331
<br />based paint)
<br />0-3
<br />Dm
<br />[qoo
<br />4>
<br />1) R17165 MW: 128 No# 171042
<br />2) - ERG: 154 �!r
<br />3) A15302 BW: 154 jrr 41 X15'732
<br />15, GENERAMRISIOFFERORSCERTIRCAIION, I hereby declare that the contents of this consignment are fully and accurately described above by &a proper shipping name, and are desaffied, packaged,
<br />marked and labeled1placarded, and are in all rasps* in proper condition for transport according to applicable Intemallional and national governments! replalkins. 9 export sthipment and I am the Primary
<br />Exporlor, t certify that the contents of this coinsitinment conform to the terms of the attached EPAA*oMedgmentof Consent,
<br />1 certify that the waste minimization statement Identilled In 40 CFR 262.27(a) ('01 am a large quantity generator) or (b) (if I em small quotility generator) is true,
<br />Go NV PLWTyped Nam 511nature r0wr, Day ear
<br />07
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<br />X'S*m"'- Import to U -S. ❑Export from U.S. Pon of envy/ext-
<br />Transporter signature (tot export only): Data leaving U.S.:
<br />i?.TmnspwWAdmwioOgmraolReWpID(Materials
<br />Tw-*ar—wi Pd-ReTypied Nam month Day Year
<br />e-j'%WU;L
<br />Z
<br />Twisircitc 2 PrintedPlyped Wm- S10"awle him4i Day Year
<br />Discrepancy
<br />I18.
<br />18a. Discrepancy Indication Space 1 11 clu"itity ❑E]Type El Residue ❑ Partial Rejection El Full Raise&,
<br />MWOest RewanceNumbec
<br />I& Alternate FK* (or 04ftratot) U.S.EPA IDNwober
<br />F Phonw
<br />WFO Day YW—
<br />. ...........
<br />19, Hazardous Waste Report Management Method Codes (Le., codes for heardous waste treatment, disposal, and recireft systems)
<br />4,
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<br />20.DwignatedFadkOwnerarOperetw.Cerff=limoffewo(nFW*ntnusrmtedoiscovemdbythS I as rded In Rem 18a
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<br />EPA Ford870M (Rev, 3-06) Previous e0fons are obsolete, `-- dIGNATED FA&L—ITY TO DESTINATION 4TATE (IF REQUIRED:
<br />
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