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L t pr,rn or type, -0 Cn <br /> D UNIFORM Form Approved,GMe No.2056- S O <br /> Cn Please punt IIAZARD❑US f,Generate,ro Number <br /> WA$7E 1NANIF 2-Page t of J.Emergency Response phone a.m� ,llw T-1,1.9 Number 0039 O W 0 <br /> EST 020445564 JJK 0 <br /> O UNIFC� S.Generators Name anti Mailingpddreys u�DG359a f' 1 16-371-5747 O N <br /> Z WE Generators Sle Address pf tlilrerem Iran mailing eddressl h N <br /> .AhIERIC.ANTnUCK&T"LER 00 O < <br /> 5.Ger 295 INDUSTRWL •• 0) <br /> D WOCCLAN❑,CA 95775 O <br /> Generators Phorr630.661�1t71 � <br /> D 6,Transp,ler 7 company Name =5 n <br /> U.S.EPA 0 Number O <br /> Z Gene RAWS ENVIRONMENTAL SERVICES INC. cq ; <br /> 6-I'm 7.T+ansPdder7 Company Name U.S.EPA 10 Number v Q- <br /> M <br /> 7. <br /> ame Aedress <br /> W Ira 6.Oesgnalud Facility Nand Site us.FPA t9 Number <br /> W PACIFIC RESOURCE RECOVERY CD <br /> 3150 EAST FICO BLVD, CPZDl-e'E2445 <br /> B.De LOS ANGELES,CA goo23 0 <br /> Facilrty'a phone.�•��'714`'` r-h <br /> S <br /> ga. n US.DOTG urr tit n{including Proper Stripping Name.Hazard Class,ID Number, 1n,Containers 11.Total t2.Unit <br /> HM and Packing Group Iii any}] 13 Wasie Codes O <br /> FaUli No. Typo Quantity Wt.No. <br /> f A ACETONE,3,PGII <br /> 6a o <br /> NM D4 7 <br /> y2 rD <br /> w <br /> O <br /> O <br /> CL <br /> (D <br /> rn <br /> �. <br /> a) <br /> 14.Special Handling instructions and Additir7nai Infermafion � a) <br /> 95-1)PR0IFfLE# ERG#1213 x� r+ <br /> E.R. CONTRACMR: PIWOS EAMORNMENTAL Q <br /> 9r HANDLERS SHOULD 6E TRAINED AND USE APPROVED PPE ✓L D f /�Z - <br /> F <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:Thereby declare that She contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable interna@onakand national governmental regulations.if export shipment and l am N Primary �r <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 stalementfdentihed in 40 CFR 262.27(a){if I am a large quantity generator}or(b)6l ap a sm uan'ty generator]is, e, O <br /> G eral& is Pdnted/Typad Nam Signature Month Day Year <br /> J 16.IntemalionalShipments <br /> 1:1O <br /> Impart to U.S. ElEtpart from U.S. Port entrylexit: Q- <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17 Transporter Acknowledgment of Receipt of MaterialsLU <br /> Q <br /> Transporter I PrintedlTyped Name Signature M Y r f7 <br /> Transporter 2 PrinledTryped Name Signature Month Day Ye ar O <br /> n <br /> v <br /> f+ <br /> F- <br /> 18 �• <br /> iscrepancy y <br /> iscrepancy IndimSon Space LJ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Futl Rejection <br /> r rn <br /> ManKest Reference Number, n <br /> emate Facility(or Generator) U.S.EPA ID Number Ort <br /> Phone: O <br /> yalureofAftemafeFaciiity{orGenerator) Month Da fD <br /> CL <br /> O <br /> dous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatmentdisposal,and recycling systems} 0 1. 2. 3. 4. v <br /> r-r <br /> O <br /> 7 - CD <br /> 20 Designated Facility Owner or Operator:Cer@Itcation of receipt of hazardous materials covered by the manifest except as noted in]tem 18a cQ n <br /> PdnfedlTyped Name Signature Month Day Q <br /> :)A Form 8700-22(Rev. 12-17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e-MANIFEST Sl = <br /> 0 <br /> v. <br /> 7G-11) Nrevlous editions are oDSolere. UtblU NA 1 LU PA%j1L11 T I U CrA s e-MAI irLa i a 1 a f cfrrCD <br /> cQ � <br /> IV <br /> _ W — Oo <br /> CO <br />