Laserfiche WebLink
Q1277.. 2C?7S <br /> ' PI ase, rim or type.(Form designed for use on elite(12-pitch)typewriter) y Form Approved.OMB No.2050-0039 <br /> ..> UNIFORM HAZARDOUS <br /> 1.Generator ID Number 2.Page 1 of 3.Emergency Response Plnnre A Manifest Tacking Number <br /> WASTE MANIFEST CALOW224152 1 1-800-424-9300 - 005782640 JJK <br /> .Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> DIABLO AUTO BODY <br /> 7710 MURRAY DRIVE ' <br /> STOCKTON, CA .95210 <br /> Generators Phone: 209-478-9971 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> PACIFIC COAST LACQUER CAROW194837 <br /> 7.Transporter 2 Company Name U.S.EPA IO Number <br /> 8:Designated Facility Name and Site Address U.S.EPA ID Number <br /> PACIFIC RESOURCE RECOVERY - - CAD008252405 <br /> 3150 EAST PICO BLVD. <br /> , LOS ANGELES, CA 90023 <br /> FadliysPhone: (800) 499-7145 <br /> gra, 9b.U.S.DOT Desaiption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tn7G <br /> 13.Wase Codes. <br /> HM and Paddng Group(if any)) No. Type Ow <br /> X 1. N 263, AS R , o <br /> PGII, RQ, (13001) <br /> 0 OM 1CLEANING SOLUTION) (CALIFORNIA REGULATED <br /> ONLY) DF f3. <br /> 4. <br /> 14.Spada]Handling Instructions and Additional Information <br /> 9b1) APO 6329 9b2) AP# 6339 <br /> GLOVES, GOGGLES. & PROTECTIVE CLOTHING <br /> ERG#: 9b1) 128 9b2) NONE <br /> TRANSPORTER 1 PHONE. # 1-800-752,1566 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that me contends of this consignment arefully and accurately described above by the proper shipping name,ard are classified,packaged, <br /> marked and Iabeleilplaarded and am In all respects in proper condition for tmnsporl according N appl]aMe International and national governmental regulations.If export shipment and I am the Pdmary <br /> Exporter,I wrdy that the contents of this consignment conform to the terms of the attachedEPAAdmowledgment of Consent. <br /> I cerNy Thal Ne xasto minimization statement'enfifred in 40 CFR 262.27(a)(4I am a large quantity generator)ter(b) am a mall uantl ra )is true.- <br /> n <br /> tor'sJO rsPriTedef Sib Na Monty Da�•Year <br /> .inwimbonmi shipments <br /> i Import to U.S. ❑Export US. Pon len /exit: <br /> Transporter signature(for exports only): Dara leaving U.S.: - <br /> W 17.TmnsponerAcb Medgmentol Receiptof MaanaN <br /> Tmnsgg9%.W BTed/Typed Name ^ - 5alum Menti Day Year <br /> doN <br /> Transporter PdntedRyped Name Sig nN Day YeAr <br /> } 16.Discrepancy - ' <br /> 18iction a.Discrepancy IndSpan <br /> ❑ Quantity ❑Type ❑Residue El Partial co <br /> al Releon ❑'Full Rejection <br /> f <br /> Manifest Reference Number <br /> 1Ib.Agema(e Facifily(ter Generator), -. U.S.EPA ID Number t <br /> J <br /> U <br /> Fadliys Phone: <br /> W ISc.Signature of Alienate Faality(or Generator) Month Day Year <br /> 6 <br /> 2 ' <br /> W2 rag.Hazardous Waste Report Management Method Codes(I.e.;codes for Iwardous waste treatment disposal,and recycling systems) - <br /> C 1:- 2. 3. 4. , <br /> 20.Designated Facility Ovner or Operator.Certification of mceipt or haiallous mat-edah commit by the mares]except3V41—in I Be( <br /> 1 Ptln edd Name SgnaNre Monty Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions am obsolete. DES NATEDFACIL GENERATOR STATE(IF REQUIRED) <br /> 10703.1848 <br />