Laserfiche WebLink
Pi s r#td ype...(Form desidnoo fot vO on elite{1 fit})iypey+ t@;} !/ <br /> �} ttNlt: �i+4ZiAi DOUs. 1;GeneratorlRNu ber, ,I: 2 agel of 3.Em .eapanSe' hone 4 MafitiestTraokingNumber ( <br /> "` IMANIFEST 'CAL=<. ���# ` <br /> �S Generat ame and Mailing ddres's ^. v Generdtbi's Site Address(ffdti(ereritthari mailfog address) <br /> A- CAL XF.DDA ADESA 'C3tKDE- RITE <br /> .01 STANFORD Ro <br /> "f"�tACY', CA .9153.7Z{ <br /> Genie"toes.Phon�.. <br /> 6,Transporter)Company Nara$": U.S,EPA Number <br /> 1�ACIFIC R OURCE" RECOVERY i�WIMSw CAt�00�26241e�s <br /> 7:Transpoiter,2,Company Name U.S.EPAiDNumbeF <br /> 0.Designates FapJlity Name and Site Address U.S.EPA1D;Number <br /> PACIM RESOURCE RECOVERY SERVICES CAG}0�18252405 <br /> l� EAST PICO LVD, <br /> ANOELrER, CA -QQ*2S <br /> Fadll $Phone: 000 498-746.. <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard.Class,ID Number, 10.:Containare .I.Total: 12.Unit 13.Waste Codes <br /> HM and Pacidng Group(If any)) No. Type Quantity WtNol. <br /> X WN12.63, WASTE PAINT RELATED NATERIAE,.. 3,. 1 <br /> Poll, kQ. (Owl) �� a 17 <br /> w � , <br /> P.7 <br /> 7 77- <br /> 006i�whii i`RW VIR <br /> s <br /> a. <br /> 14: pedal Handing Instructions and Additional Information <br /> 0 ) APS 6S 28 9 <br /> GLOVES, GOGGLES i RD CT E E :THIN" �.4#fiR EMfiRD�Y, � y t3RF <br /> � all oil RK . <br /> T " EPtRTR I•. <br /> 15 GEN RATOtt`.S/OFFEROR'S CtRTiFICATiDN,.I hereb declare the(the:contents of this consignment are fully and acsirafelydescribadAV by the pro*-Alpping name,and ere.dassified,packaged, <br /> narked and:tab6led/placarded,and ire 1ri ail resgAGls m Lwroperiond(flon for transportacowing to apPllcaMs intemationatand nagon"ai govefntnenfet':repuladons,if expott'shipmeht andl am tha Rr!}nary <br /> EXportar,}certify that the contents of this cons(gmtieit nfornt;to tfie,terfns otuza attadted EPAAdsnowiedgmant of Consent; <br /> toert fy that the waste minimizat)oti•stateindmt idenh`flbd�n t0 C�R28g:27(a):(if i am'a large quantity generator}or.(b)(if l am a&mall g4anti gerrerstot)Is Uue. <br /> gator sl ero�rysgPrint6d/T Name �} SI tore Month Day Year <br /> j "` • <br /> 6:In rnational.shipments, <br /> 0"Import to U.S. Q Export from U.S. Port of entry/eziti <br /> Transporter signature(for exports only): Date leaying U..S,. <br /> 17.TranspoderAcknoMedgment of Reoeiptof Materials . <br /> Trans ntedlTyped Name Ig Month Day. YearIx <br /> /.S ! <br /> a Transporter 2 PrintedlTyped Name Month Day Year <br /> r <br /> 18.Discrepancy <br /> 183',Discrepancy Indication Space y <br /> El Quantity Q Type Residue 0 Partial Rejection. ❑Full Refection <br /> Manlfest.R rence Number. <br /> i8fi.Alternate Facility(or Generator) U.S.EP&P ftmber <br /> U. Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z e <br /> N18.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste traMent,disposal,:and recyciingsystems) <br /> 1. 2 <br /> 13, <br /> .. 4. <br /> it , <br /> 20.Designatep,faciilty Owner or Operator.Certification of receipt of ha#ardous materials oovered'by the manifest except as noted in item 18a _ <br /> Pnntet�ypedName` Signa Mth Day ear ... <br /> EPA Po .t3� Rev: t)5)"Prev se (ons-a obsolet . DESIGNATED FACILITY TO GI�NERAT R <br />