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` d Please print 1 type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 11NIf ORM HAZARDOUS 1.Generator ID Num er 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number VVAbfEMANIFEST CADt 54598'289 1-�Gx�. 424- '30A 100 3 r 'i JJK 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) ;df1480R ::H11EV(tVV:CCL 1210D C t.HERiKEE LANG. L0f)T, CA 95240 Generators Phone: .209 3.3 4-5 6.Transporter 1 Company Name U.S.EPA ID Number PF>G1F IC COAST LACQUER t:A;10082524ob 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number PACIFIC' RESOURCE MECO FRY CAD008252405 3150 EAST P:ICO BLVD. LOS ANGELES, CA 90323 Facility's Phone: (1 00) 499. 71 a ga 9b.U.S.DOT Description(including Proper Shi ping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Packing Group if an Quantity Wt.Nol. 13.Waste Codes HM 9 P(� Y)) No. Type tY 1•UN1263, WASTE PAINT RELATED MATERI&Ai_, D00'! i':C60.3 ote) o D- P RQ (00 1) 0 0M �'j � to 214 l!JPi i �r_.n Ln 7 A. nni r 2. ai r� LU C 9AA,!NP 9 1)';7.^al�y, � r-yLZ•-r��Sr��cT•S'CS 1 S7 9 ��.._�� 3. i 4. i 14.Special Handling Instructions and Additional Informa'on 9 b 1 ) A P4 9 CLOVES, 6t:E�GLrS nf,r] C.I7VE t CLOTHING ERG*: 9b1) 123 TRANSPORTER 1 PHONE 4 1--KND-75 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I ereby 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 respe is 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 consign nt conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement iden Pied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generators/Offerors Printedrryped Name Signature Month Day Year Uyl 116.International Shipments � ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transp2rWLLerinted/Typed Name Signature l! Month Day Year 6 Z Transporter 2 Printedrryped Name Si na reJ /% Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 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