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T <br /> t s r'f I�)ase print or type.(Farm designed for use on-elite(427pitch)typewriter.) Form Approved.OMB NQ-2050.0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL-000371213 1 800)424-5:00 0,17792478 JJV. <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CERTIFIED COLLISION CENTER <br /> 7710 MURRAY DRIVE <br /> STOCKTON CFS 95210 <br /> Generators Phone: 209 830-9300 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> MBURYEIMRONMENTALZERVICIE— - "2 2 B 2 7 7 0 3& <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> DEMENNO/KERDOON <br /> 20¢0 N.ALAMEDA STREET <br /> COMPTON CA 90222 CATOBOOISS52 <br /> Facility's Phone: ay fi <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers t1.Total j 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity W11V01. <br /> .0 1 NON-RCRA HAWDOUS WASTE.LIQUID(WATERBORNE PAINT) <br /> c� <br /> l DM rl f a G <br /> LU 2 <br /> w <br /> c�. <br /> 3 <br /> }k <br /> 4. T <br /> 14:Special Handling Instructions'and Additional lnformalion <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249304 WOES TERMINAL:CERE'S CS SM_RG#981:171 *PROFILE 0 9131 <br /> 42 983 WATERBORNE PAINT * -APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT # 2b7_9 ill'k S�.— <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descdbed,komby 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 international and national governmental regulations.II export shipment and l am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Ca sent. {'�� <br /> I cerlify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity generator) r(b)(i 9m a snla(g-,AJIy gW.ralor)is true. <br /> en ralor'sfofferor's PentedlTyped Name s ^ , Month Day Year. <br /> 16,International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> 13� 17.TransporterAcknowledgment of Receipt of Materials <br /> LU <br /> Trans er1 Printed ped Nae f l Signature / Month Day Year <br /> QTransporter 2 PrintedfTyped f(lama Signature /fr Month Day Year- <br /> < (/ <br /> t- <br /> 16.Discrepancy <br /> 1Be.Discrepancy Indication Space ❑ quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_. <br /> U <br /> eat Facitiiyrs Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> z _ <br /> 19.Hazardous Waste Repor[Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and racyciing systems) ' <br /> Q 1� � r 2, 3. 4. <br /> 20.Designated Facility Owner or,0perator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedfryped Name Signature Month ay Year <br /> tc <br /> EPA Form 8700.22(Rev.3-65) Predie4&ditions are obsolete. DESIGNATE CILllTO-GENERATOR STATE f(IF REQUIRED) <br />