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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMS No.2050.0039 <br /> UNIFORMHAZARDOUS 1 Ganerator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Numbor <br /> WASTE MANIFEST 11 <br /> CAUX0 ^f 0'1 ���� <br /> S.Generaloes Name and Mailing Address _ti?a <br /> Generator's Site Address(if different than matting address) <br /> �_1i•,108 OIL i,=1.-:TC�C',i i if�r <br /> rC 59/.011;3n IPI:JC`.1 h.,a,�,'Hx!''OR.K,IA) fat?i�irly"'i t'C. <br /> PEST'.ACPANIENTO; 35531 STOCI CFI,u} �2+:= <br /> Generators PhonaK;.,,-�,�r,.�==.; <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> ri�.140G EPlbrinfli<11v1Ei;TAL <br /> 7.Transporter 2 Company Nama �E;'L4CES ii-1C. Cr L'0�(003a5o <br /> L•' U.S.EPA ID Number <br /> (-- "{1(t^n.e L-t/C./ <br /> B.Designated Facility Name and Site Address L!a 12- L <br /> PACIFIC RESOUP.C_PSCJrU.S.EPA ID Number <br /> :• <br /> 3150 E4.sT PICO BLVr. CAG003L52dJS <br /> LOS ANGELES,Com. 900"•3 <br /> FaaitysPtone:600.499-7145 <br /> oa, 9b.U.S.DOT description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers <br /> HM and Packing Group(f any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity WWW. <br /> 0 1' U01�U3,APIAS T--GASOLINE, PGI c�i Dr:) G 34-3 � coat �c�1a <br /> z 2. I t <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information I I <br /> @E-1)?ROFIL�4j 1131 i006)9 %P ,123 <br /> P. COP1717"C OR: P.AiviOS EfjV ROAIn,1E1I AL <br /> HAPIOLEF.S SHOULD eE TRANN-50 A 10 IJSE.4ppRO?!ED PPc <br /> 15, GENERATOR'SiOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and ac umlely described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledipiacarded,and are in all respects in proper condition for transport according to appikaWe international and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,I cerlify that the contents of this consignment conform to the terms of the attached EPAAcknowledgrnent of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator )(OI am a small quantity generator)Is we. <br /> Generatoesr08eroes PrintedfTyped Name Sig a Month Day Year <br /> W. <br /> r 16.I emational Shipments <br /> Z Import to U.S. ❑Export from U. . Pod of entry/exit: <br /> Transporter signature(for exports ordy): Date leaving U.S.: <br /> LWfFacillysftone:ransporter Acknowledgment of Receipt of Materials <br /> porter 1 PrinledlTyped Name Signature Month Day Yeaz <br /> Transporter 2 PdntedfTyped Name Signalure Month Day Year <br /> �'/pa / lr� /suepancyisuepancy Ind_t SpaceEl quantity ❑Type ❑Residue ❑Partial Rejeclion ❑Full Rz ecbn <br /> Remkale Facility(or Generaler) Manliest Reference Number. U.S,EPA ID Number <br /> s Ptone:gnature ofAltemate Fa a6ty(or Generator) 0a1 Year <br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recydbg systems) <br /> w 1 <br /> C:, <br /> 20.Designatad Facility O mor or Opemlor.Cedificalion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Namo Signature Momh Day Year <br /> C'- <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete, OEgI, -,ry0 iJ',-16CiLIT;'TO DESTIM,'i IOP!STATE(I REQUIRED) <br />