Laserfiche WebLink
Please.print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMS No.2050-0039 <br /> UNIPORM HAZARDOUS i.Geremlar ID Number 2.Page fort 3.Emegency Response Phone 4.Mani Tacking Number JJK <br /> WASTE MANIFEST CALNCd0224152 1. 1-€hfo-'424--93eo ,vee1l ((77((00772640 <br /> oGenemtofs New and Mailing Address I Genemlofs Site Address(if dilfarent than mailing address) <br /> OIAFJLO AUTO BODY <br /> 771.0 MURRAY DRIVE - <br /> BTOCKTON, CA 9521.01 <br /> Generator's Phorre: 209-478-9971 <br /> 6.Transporter 1 Company Name U,' <br /> .FPA"W <br /> D Number <br /> PACIFIC COAST LACQUER CAR GJCZY:14'r..37 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Deshipi led Facility Name and Site Address U.S.EPA ID Number <br /> PACIP:CC RESOURCE RECOVERY .o' CAE1a]uit'?�240ti <br /> 31.50 EAST PICC BLVD. <br /> LOS ANGELES, CA 9CIO23 <br /> Facility's Phone:. (600) 499-7145 <br /> ga 91b.U.S.DOT Description(including PmperShipping Name HazardClass,ID Number, 10.Conlmnere 11.Total 12.Unit <br /> HM and PaGroup Pal Type Quantity Wtivol, 13.Waste Codes <br /> cking <br /> X 1.UN..1 '63, M1 t 1.. 1 .. .. ;t, <br /> o t'G f 1'., RO, (OW,n I Y <br /> DM 1 <br /> Z2. 3. {! 1. .{.., <br /> I <br /> w C;;-;ANS€!G S )tUT1f1N) (CA1..l(FORNTA REGUlATE,D / <br /> ONLY ` Df' G <br /> 3. <br /> 4. <br /> 14.Special Handling lrreWdions and Adclohnal Information <br /> 914-1. ) AP# 53'"9 9b2') AP# (3339 <br /> al-(NES, G0fl11.ES & PROTECTIVE CLf3TH1:NG <br /> F'_R001 9b! ) 12R 9b'') NONE <br /> TRANSPORTER 2 PHONE # <br /> 15. GENERATORWOFFEROR'SCERTIFICATION: I hereby declare that Ore contents of this consignment are folly and accurately descried above by the proper shipping name,am are dassieed,packaged, <br /> marked and labetedlplacarded,and are in all respects in proper condition for transport according to applicable international national governmental regulations.fI export shipment and I am the Primary <br /> Exporter,I coney Bat the convents of his consignment conform to the terms of the attached EPAAtlmowledgmentof Consent. <br /> I wily that the waste minimization statement is nifill in 40 CFR 262.27(a)(i I am a large quantity generebr)or(b)(dram a pmaipuantl eratCfl is true. <br /> n T lofsrOlial tedRyped'7 1 Si lure r Month Day Year <br /> 16.In ational Shipments <br /> iElbroad to U.S. El wit Nom trylexi <br /> U.S. Pod of en <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> K 17.Transporter Acknowledgment ofRomiptofMaterials <br /> TmnsRRgbecLPmt@Nfyped Name - n Sgnabue Month Day Year <br /> 2 Tmnsp°der 2 Printed4yped Name 'Sig ,jMOM Day Yeal <br /> t18.Discrepancy <br /> 18a.Discrepancy Indcatlon Space ❑ Quenall ❑Type ❑Residue ❑Partial Rejecean ❑FM Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA IO Numban <br /> J <br /> U <br /> LL <br /> Fal Phone: <br /> W 18c.Signature of Alternate Facility(or Generates) Month Day Year <br /> 6 <br /> z <br /> 19.Hazardous Waste Report Maregemenl Method Codes(I.e.,codes forhazerdous waste heaMard,disposal,and recycling systems) ' <br /> 1. 2. 3. 4. <br /> �.. _ <br /> 20 Designated Fadlny Owner or Opemlor Cerbkakon of rwWpt d hazardous materia covered by ire mardest exceptas nded in item 182 - <br /> Pnnted?,yped Name ,z Slpnatum. ) Month DayYear <br /> i { <br /> EPAForm 87OD-22(Rev.3-05) Previous editions are obsolete. t - TRANSPORTER'S COPY <br />