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P print or hroe. (Form desioned nfor el <br />use on ite t12.rutrhl tvrewrite� 1 ' I <br />Form Anoroved. OMB No. 21lsum39 <br />12242.2080 <br />UNIFORM HAZARDOUS 1 1 • Generator ID NOmber�- ' <br />•• c 11 <br />2: Page-twf <br />3: envy Response,Phone <br />4. Manifest T//rr�addng Num <br />®14 <br />WASTE MANIFEST <br />916,371-6747 <br />l3'2'68 JJ <br />5. Generators Name and Mailing Address Generators Site Address (11 different than mating address) <br />PRODUCTION- CHEMICAL MANUFACTURING IPSO. <br />r 101X1 E CHANNEL ST. <br />STO&M. CA <br />Generaich Phone: 7337 <br />6. Transporter 1 Company Name - ' U.S. EPA ID NMmbar <br />t <br />ti RAMOS ENVIRO01MENTAL SERVICES INC. <br />7. Transporter 2 Company Namer U.S. EPA ID Number <br />; <br />L <br />t o � C, > L {� C A 12- 0 ®.� 2 --Li <br />8. Designated Facility Name and Site Address U.S, EPA ID Number <br />PACIFIC RESOURCE RECOVERY 05 <br />3150 EAST PICO' BLVD. . <br />IAS ANGELES. CA 913023 <br />Fadftys Phone:80D,�7145 I <br />ga• <br />9b. U.S. DOT Description Oncluding Proper Shipping Name, Hazard Class. ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Pig Group (t anY)) <br />Quantity <br />WtJVof. <br />t. UN121I3. WASTE PAINT RELATED MATERIAL, 3, PGID <br />001 <br />DM <br />G <br />343 DDD1 <br />ILA <br />2. _ <br />'r <br />ra <br />�.. <br />3 <br />y <br />F <br />4. 1� <br />14. Special Handling instructions and Ad I Information <br />99.1y ..►.4'®g007a ERGM2B <br />"E.R. R: RAMOS EWRONMENTAL <br />HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE <br />15. GENERATOR`SIDFFEROR'S CERTIFICATION: I 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 labeWpiscarded, and are In all respects in proper condition for transport according to applicable international and palional governmental regulations. t export shipment and I am the Pdnvq <br />Exporter, I ow* that the contents of this consignment conform to the terms of the attached EPAmanto'Con <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (IfI am a large quantity genere rf Ia small quantity generator is true. <br />Genera yped r^^ Sighf-hue Mo h D Year <br />1 <br />_r <br />F— <br />16. International Shipments <br />. ❑Import to U.S. ❑ Export Port of entryle)dt <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />17. TransporterAckraMedgment of Receipt of Materials <br />Cie <br />a <br />e Month Year <br />TripsawW 1 Pdntedf, 7,1=. L+ ' <br />♦ <br />CO) <br />. 1 <br />T 2 Pd Name Signature Month Daayy» Year <br />F5 <br />16. Discrepancy <br />18a. Discrepancy Indkxtton`Space ❑ QuantlY ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number <br />18b. Aftemate Facility (or Generator) U.S. EPA ID Number <br />J <br />. <br />toe. <br />Facility's Phoma: <br />18e. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />y19. <br />Hazardous Waste Report Management Meted Codes (.e„ codes for hazardous waste treatmeK disposal, and recydhx3 systems)' <br />® <br />1, <br />3. <br />4. <br />20. Designated Facility Owner or Operator Certification of reWpt of hazardous materials covered by the mar*d except as oadA Item 18a <br />ted/Typed Name <br />k^�+,,,, <br />EPA Form 8700-22 (Rev. 3.05) Previous editions are obsolete. nFC1r.MATFn F®[_It ITV Tn c'.FNt±RATnR'-QTATg: tic RFnt oro <br />12242.2080 <br />