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(Form designed for use on a ite(12-piic I typewriter.) Form Approved.OMB No.2050-0039 ,X HAZARDOUS 1.Generator ID N mber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number iASTEMANIFEST CAOG�+r,�s5987_39 1--800-42.4_93�'90� {'y-�S n n r- ,,m �,� JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing'address) 1210 S. CHEROKEE LAP E Ml, CA 95240 Generator's Phone: 279 ;334- SOW S.Transporter 1 Company Name U.S.EPA ID Number . ? ��'_F1: COAST LACQU' R i 1W 8 7,Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number (PACIFIC RE'SMIRCE REC VERY CA000825.2405 3150 EAST PICO BLVD. LOS ANGELES„ CA 9002 ' Facility's Phone: (800) 4931-7145 ga, 9b.U.S.DOT Description(including Proper hipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1.U IN Ie D.j, WA`)I t 1,'A 14 h{It r_M i C_L IylA :{1,-,L o PGII, RQ, (0001 j Qd .. 214 WLU 1 V-11A ! 3. 4. I L� 14.Special Handling Instructions and Additional Info ati, 4b-1 -j. A -4 -P,# 6 .29--�,2�.A 4. Ma - CLOVES, GOGGLES & PRO -EC' E C OTHING ERG#s 9bl) 123 T RAiNSPORTc Ft 1 PHONE * 1'-8110-752-1566 15. GENERATOR'S/OFFEROR'S CERTIFICATION; I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all resr ects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement ide itified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year u N 1 �ia,,:uL' �6'�'� L`�r •�.ua , '^r� / �' 16.Intemational Shipments ❑ i Import to U: . ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials t TranspodeH, ted/Typed Name Sign tuhe Month Dai Year aTransporter 2 Printed/Typed Name ignaty /;/� Month Day Year 18.Discrepancy 18a.Discrepancy Indication SpaceEl - ri ❑ . Quantity ❑Tpe ❑yResidue Partial Rejectio -Full Reje-,ction Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ L) I Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2• 3. 4. 20.Designated Facility Owner or Operator:Certification o receipt of hazardous materials covered by the manifest except as noted in Item 18a- Printed/Typed Name Signature - Month Day Year , EPA Form 8700-22(Rev.3-05) Previous editions are o solete. `- DESIGNATED FACILITY TO GENERATOR