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Z/l// <br />State of California fnvironmenfal Protection Agency— <br />, rm�%1p$roved OM No 2050-0039 (Expires 9-30-99) <br />See If15tFUCtlOI1s <br />t <br />pnnt or type.. Form designed for use on elite (12-pt, <br />on back age' 6. <br />-Phase <br />ewriler. <br />_ /' <br />1 Department of Toxic Substances Control <br />UNIFORM HAZARDOUS 1, Generator's US EPA ID No. <br />anifest Document No.nt <br />Sacramento, California <br />2: Page 1 Information in shaded <br />WASTE MANIFEST C L ©v I L 1 <br />areas <br />is not required by Federal law, <br />3. Generator's Name and Mailing'Address <br />of <br />Q6 Rebuilders <br />St ")vlaniFesi Document Number <br />. <br />V <br />25 W. Chatty WADI Stockto457,4 <br />n, v.MB, <br />1 <br />State <br />4,- Generator's Phone ( 20+07,),1 Au <br />Generator's ID <br />,. <br />(V <br />st. Transporter 1 Company Name <br />- <br />ao <br />O <br />6. US EPA ID umber <br />b <br />Ramos Environrr►errtal Services <br />C: State Transporter's ID <br />, <br />O <br />T <br />n a 5 <br />v v <br />D, Transporter's Phone <br />J <br />J <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />- - <br />E. State Transporter's ID - <br />Q <br />U <br />9. Designated Facility Name and Site Address <br />F. Transporter's Phone <br />Z <br />Pack Resource Recovery 10. US EPA ID Number <br />G. State Facility's ID <br />m <br />M <br />3150 E. Pico Blvd. <br />v <br />o <br />Los Angeles, C�. �.�Q <br />5240 <br />H. Facility's Phone <br />yy y g j <br />,1CAPQQQ <br />� <br />L <br />US DOT Description (including proper Shipping Nome, Hazard Class, and ID Number) <br />- <br />12 Containers <br />No. <br />13. Total <br />14. Unit <br />/ Z <br />a. <br />Type <br />Quantity <br />Wt/V01 <br />I: Waste Number <br />0 <br />ri <br />Waste Flammable liquid,nos,3,UN99�3,PGlA (DflOi) <br />State <br />� i <br />E <br />r <br />b. <br />! / <br />EPA/Other-,A <br />o <br />N" <br />x <br />m <br />E <br />Non RCRA Hazardous Waste Liquid (brake fluid) <br />331 <br />v <br />v <br />R <br />A <br />EPA/Other <br />o <br />m <br />T <br />OIL <br />- <br />5}ate <br />IL <br />R <br />o <br />d. <br />EPA/Other <br />Fes'-- <br />Z-- <br />w <br />._ - . - - - --'•-- <br />State <br />ut <br />v) <br />J. Additional Descriptions for Materials Listed Above <br />I I <br />EPA/Other <br />0}Z <br />,yMRn gyp / <br />.r�5:i l�J+f' 1 L8 - <br />K. Handling Codes for Wastes Listed Above <br />171 <br />Q <br />�{� 1 ` J 6/ ° 0� <br />c- <br />d. <br />Z <br />E <br />0 <br />15. Special Handling Instructions and Additional Information <br />Handlers should be 40 hour oshalsara trained <br />Z <br />= <br />and use niosh approved ppe <br />tMC�Lrrc�7,: CPJ`-iA- �`{16a� 3r1--5- W 17 <br />J <br />Job # X157If Prom *# <br />--+ <br />U <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig <br />rnment are fully and accurately described above by proper shipping name and are classified, packed, <br />ma ked, and labeled, and are in all respects in proper condition For transport by highway according to applicable international <br />and national government regulations. <br />hJ <br />If I am a large quantity generator, I certify that I/ hove a program in place to reduce the volume <br />practicable and that I have selected the rracticable method <br />and toxicity of waste generated to the degree I have determined to be <br />a <br />0 <br />economically <br />of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have made o good faith effort to minimize my waste generation and select the best waste management method that is t <br />available to me and that I con afford. <br />i <br />1- <br />U <br />Printed/Typed Name <br />Signature <br />• w <br />5 Cr <br />ay Month Day Year <br />(D <br />T <br />R <br />17. Transporter 1 Acknowled ement of ecei t of Materials <br />t <br />l <br />1 Z <br />w <br />A <br />NSi <br />Printed/Typed Name <br />ature <br />', <br />r t1J <br />S <br />P-t( <br />r...._ <br />.. <br />J t/9q <br />Month Day Year <br />r <br />0 <br />0 <br />IS. Trans orter 2 Ack wled ement of Recei t of Materials <br />b, <br />Lu <br />T <br />E <br />Printed/Typed Name <br />Signaturer�"� <br />v) <br />Q <br />R <br />Month Day Year <br />U <br />19. Discrepancy Indication Space <br />I L k1 <br />1 <br />Z <br />— <br />F <br />A <br />C <br />) <br />( <br />Y <br />20. Focili Owner or Operator Certification of reC' 1 "`f hazardous materials covere th' anif <br />Printed/Ty N <br />Signature <br />except as note 'a lte 1 vT <br />t <br />M — <br />DO NOT <br />Yellow: TSDF SENDS THIS COPY TO G <br />EPA 8700-0-22 NERATOR WITHIN 30 DAYS. <br />DTSC 80 (4/97) (Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />