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Please print a type.(Form des ned for use on elite(12-pitch)typewriter. <br /> Form Approved.OMB No.20550- <br /> UNIFORM HAZARDOUS i.Ganamfor ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest hacking Number <br /> WASTE MANIFEST000269375 000771168 <br /> G B F <br /> S.Gemareiafe Nems and Melgrg G.'"fifirwo Prdiffemand than maikg adders) <br /> PICK-N-PULL 11190- <br /> 3927 CLARK DRIVE <br /> q,,aUQ 4kS DN. CA 95205-8231 <br /> 6.Tramaporler 1 Company Name 209-zM-1921 U.S.EPA ID NL4T&v 1 <br /> 7.Tanspaner2Ca any Na U.S. <br /> 8.Designated Facility Name and Site Address �� itS.FPA ID Number <br /> Tl190 k). rkG �I"- WW00002W51 <br /> 1O1-M=e-n Dr AGa 7'3,6 <br /> F 4 of-$72- c(l Ul Ca-ro ?8'7 Ivelq 9/ <br /> ga eh.U.S.DOT Description(xdudng Proper Shipping Name,Himard Class,ID Number 18.Containers it.Total 12.Unit <br /> HM and Pack"mg Group Of any)) <br /> No. type Quantity WI Nd. 13 Wale Codes <br /> 1. <br /> 0 Non-RCRA Hazardous Waste Solid Z DM GUi P -- <br /> w <br /> z 2. <br /> w <br /> c� <br /> 3. <br /> 4. <br /> W Special Handing Insructlons and Additional Infurwhon q <br /> Weal-Pnotective Clothing and Eyewear 9.1 -gILY ABSORBENT 1x55 E.R.G.-9.1 #171 <br /> 18ENERATOR OFFERDR'SC RTIFICATION: I hereby declare that the contents of this consignment me fuM and axtindoly described above by the paper shipping name,and aro classified,packaged, <br /> marked and labeled(pncarded,and are in ag respects In proper cond6on for imnspod according to applicable International and national governmental regulations.If expert shipment and I an the Primary <br /> Exporter,I codify that the contents of this consignment coNam to the tams of the allached EPA Acknowledgment of Consent. <br /> I ceNy Thal the xaste rninkn®tion sWtemem Identified in 40 CFR 26227(a)Of I am a large quantity generator)or(b)Or am a awl quantity generators is one. <br /> (33enembfs/Ogerofs PdntetTirced Name Signa Month Day Year <br /> C ; A) I ffl 16K <br /> s.InlerretbrrW SNpments <br /> F ❑import b U.S. ❑Export fromn U.S. Pdtafentykdt: <br /> = Trensporterslpnxlumporexpealsonly): Date leaving U.S.: - --- <br /> wIT TrempaderAcknodsdgmant of Racier of Materials <br /> Transporter f Prinled/Typed NameSigna Month Day Year <br /> g rn u» ort /0 !. o <br /> T 2PdntedRyped Name Sgnatum 41 Month Day Year <br /> lY <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indiralion Space <br /> Quantity ❑Type ❑Residue El Ended RejeciDn ❑FJI Rejection <br /> Manfost Rekmnce Number. <br /> 18h.Alternate Facility(or Generator) US FPA ID NImbar <br /> J_ <br /> V <br /> LL Farchys Phone: <br /> w 18c Signature DfAltwmle Easily(aGenerator) MaAS Day Year <br /> a <br /> Z <br /> N19.Hazardous Waste Repart Management Method Codes(ia.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D I. <br /> Y 2, 7. 4. <br /> Li039 / _ <br /> 2g.Designated Facility Carrier or 02k,br.CertNcatlon of receipt oth Nous motorists covered hy the nwilfesl except as noted in item 1B <br /> tedn*d Name soahra Malh Day Year <br /> EPA Form 8700-22(Rev.3-05) Pearbus edilims are obsolete. p <br /> ESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />