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_ x <br /> Please print or (Farm designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.20504M <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Pho- 4.RWffnt Tracking Number <br /> WASTE MANIFEST CAD 9 8 2 9 7 6 2 2 8 S (800)424-9300 016870188' JJ K <br /> 5.Generators Name and Malting Address Generators Site Address(f different than mulling address) <br /> BIG VALLEY FORD-PARENT-SIG172 <br /> P.O.BOX'690388 <br /> STOCK TON CA 95269 3282 AUTO CENTER CIRCLE <br /> Generator's Phone: 209 870-4352 STOCKTON CA 95212 <br /> s.Tr�1�Open TRONMENTAL SERVICER U.S.EPA ID Number <br /> !L CAD028277036 <br /> 7.Transporter 2 Company Naive <br /> U.S.EPA ID Number <br /> 8.Desi noted Fadlittyy,,N��a��m� e and Sita Addrsss U.S,EPA ID Number <br /> PJCIFIC R!SSOURCE RECOVERY <br /> 3150 E.PICO BLVD. <br /> LOS ANGELES CA 90023 C A I)O O$2 5 2 4 0 5 <br /> Fadi es Phone: (800)499-7145 <br /> 9a. tib.U.S.DOT Description(hrGuding Proper Shipping Name,Hazard Class;ID Number; 10.Containers 11.Total 12.Unit <br /> HM and Paddng G-P(if any)) No. Type Quantity Wt Hol. 13.Waste Codes <br /> a UN1263.WASTE PAINT RELATED MATERIAL,3.PGII 1 3 5 <br /> 0 <br /> 9 / D M �t P 143 <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Hs1 Ang inii5Rons and Additional'Wo matlon <br /> EMERGENCY CONTACT:C14EMTtREC 1-800424930 WOES TERMINAL:CERES CS NAERG#981:128*PROFILE#F 981: <br /> 17040230 PAINT COMMOD17Y PACK*P5004006NS2*APPROPR#AATTEsP�PE EQUIPMENT <br /> 15. GENERATOR'SWFEROR'S CERTIFICATION:I hereby declare that tate contents of this consignment are ebe acrd <br /> marked and labs ly and <br /> described above by the pn>pef shipping name,and are dassNiad,packaged. <br /> ithat the conte and are in aA respects In primer condition for transport attached <br /> EPA o knowledg err of Cons and rra8onal govemmeniat regulations.tf export shipment and I am the Primary <br /> Exporter,lcertily that the swnlertis of Ails consignment to the terms of the attached EPAAdexrrAedgma<M of Consent. <br /> I cetRY that the waste minimvation statement Identified in 40 CFR 282.27(a)(d 1 am a large quantity generator)or(b)(if 1 am a smait quantity generator)is true. <br /> Generatoes/p rrs RnW- yped Name Signature \ Month Day Year <br /> l <br /> i8.Intemational Shipments .� <br /> ❑Import to U.S. ❑Export from U.S. Part of entrwok <br /> Z Transputer signature(tor exports only): <br /> Date leaving U.S.: <br /> 17.TransporterA*amedgmem of Receipt of Materials <br /> Tra r 1 Printad(typed Na <br /> –- --� Month Day (/Year <br /> Transporter 2 Printedfl'yped Name Signature Month Days Year <br /> rr- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Resat. ❑Partial Rejection ❑Full Relecft <br /> 18b.Akemate Facility(or Generator) Mantffest Reference Number <br /> a <br /> U.S.EPA iD Number <br /> tom+- FadiAy's Phorre: <br /> LOU 18c.Signature ofAitema Faculty(or Generate) MaNh Day Year <br /> 19.hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment disposal,andLU recycling systems) <br /> G 1. 3 4 <br /> 20.Designated Facaility Owner kbpsrator Ceifitca0on of receipt of hazardous maWals covered by the manifest except as noted in item 18a <br /> t bd/Typed Na Signydite(7-F)r� C.-I a(c, ---1, <br /> th y <br /> `1 <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNfift6 FACIGIft TO EPA's e-MANIFEST SYSTEM <br />