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Please print or type. (Form designed for use on elite ( 12 pitch) typewriter.) Form Approved. OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2, Pago 1 o1�800424! 9300 <br /> 3. EmoigenResponse Phone 4. Manliest Tracking Number ; <br /> WASTE MANIFEST C A L 0 0 0 3 5 4 3 0 6 1 CHIffF JJ K <br /> 5. bN �' M 91Kb /GEWEKE AUTO & COLLISION CTR bto' ' t MU t 89' 91NC;nZ9W9 AUTO & COLLISION CTR <br /> PO BOX 1210 102 HANSEN DR <br /> LODI CA 95241 LODI CA 95240 <br /> Generator's Phone: 2 0 9 3 6 5 2 5 1 2 <br /> 6. TrNIP06COWIT pq IRONMENTAL SERVICES INC C A R U10 a0 0 1 7 1 0 1 7 <br /> 7, Tanspotter 2 Compiny. Name U.S. EPA ID Numbur <br /> WORLDWIDE RECOVERY SYSTEM INC C A R 0 0 0 1 7 5 4 2 2 <br /> 8. l"Vtetj5lbD1oTjNt Re Address U.S. EPA ID Number <br /> HWY 95 11 MI S OF CY 16 ACRES <br /> BEATTY NV 89003 <br /> Facility's Phone: 775 553- 2203 N V T 3 3 0 0 1 0 0 0 0 <br /> 9a, 9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Numbur, 10. Coulainors 11 . Total 12, Unit 3. N <br /> iaslu Cedes <br /> HM and Packing Group (if airy)) No. Type QuantityP7tNol. <br /> 1. - A S Si -D 343 ! j <br /> o PAINT RINSATE ) p � <br /> / " I I <br /> w 2 j <br /> 0 <br /> 3. 1 <br /> I <br /> 4, <br /> 14. Special Handling Instructions and Additional Information - vvater Based Oaintnsa e <br /> D A HMD11t(84140 BE dIO( IIL 'CRr\WED ANll 1.18E PPH. . ER Contract (f 205907 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby 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 labolod/placarded, and are in all rospects in proper condition for transport according to applicable intantalional and national govarnmental 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 EPAAcknmviedymenl of Consent. <br /> I certify that tete waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity genuralor r (b) (if I am a s tall quantity generator) is true. <br /> Gene Offeror's rinlu rypgdNSItTi� � � Signaler . e Man i IN <br /> Pao \J GAr 1 8 <br /> J 16, International Shipments rII <br /> z u Import to U.S. � Export from U.S. Port 'r7e ryloxiL• <br /> l — Transporter signature (for uxputts only): Date Inaring U.S,: <br /> UW 17. Transporter Acknowledgment of Receipt of Materials <br />[ Transpottor i Printo(YTypod Name , / Siguaturo hlonth Day Year <br /> I n0 +✓ f � �lil � r� �( 2't ' 0 61 ( 0 <br /> U) Trai s rinte p Namu r G t nth On Y <br /> Q /I/00000p� <br /> I � • <br /> 18. Discrepancy rr�� <br /> 18a. Discrepancy indication Space El quantity u Typo ❑ Residue ElPanial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> U1 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> z <br /> 0 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> rn <br /> 0 24 A19iiated <br /> Facility Owntr 0pumlor. Certification of rerulpt of I zm ous materials covered by the manifest except a, tdec in Item 18a <br /> Prinled7Typm1 Name Siynamro id If Year• <br /> c Vo <br /> Forn10700.22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED ) <br />