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Stc i—Environmental Protection.Agency Forn. `MB No.2050-0039(Expires 9-30-99 See Instructions on back of page 6. Department of Toxic Substances Control ,Please„ type. Form designed for use on elite(I -pitch(ty' ''er. Sacramento,California UNIFORM HAZARDOUS 1. :rotor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal low. WASTE MANIFEST C A O Cr 4 E ca B ; 6 S 2 5 4 of 3. Generator's Name and Mailing Address A. State Manifest DocumentNumber „ r t t•.� /fit r._ _ �. SANBORN CHEVROLET a. � O 3.21.0 S. CHEROKEE LANE B. State Generator's ID �n L001, CA 55240 1`11 4. Generator's Phone (.(a� 334) �r t- 'moi & 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] LO o 'PACIFIC COAST LACQUER 5 4 � ty D. Transporter's Phone (IRM) 752-1566 O ' 0 -7;-Transporter 2 CompanyName-- —- 8. US EPA ID Number - E. State Transporter's ID[Reserved.] F. Transporter's Phone Q U 9. Designated Facility Nome and Site Addre s 10. US EPA ID Number G. State Facility's ID Q`a PACIFIC RESOURCE: RECO ERY IC JA ID 10 10 16 12 15 12 14 10 15 � iZ s15� BAST P1C 0i] `{Q. H. Facility's Phone -10 LOS ANGELES, Cry 90023 A; O � Q E Z �; C' 4 C1115 (800) 499-7145 �f 12.tContainers13. Total14. Unit Q 11. US DOT Description(including Proper Shi ping Name,Hazard Class,and ID Number)U Quantity Wt/Vol I. Waste Number Z Statea. C:TC MA� �' � 'U EPA/Other G - -- ==— E 6. State N R'Q WASTE PAINT RELAT D MATERIAL. 3, UN1263, rPGII _ 214 CP E A f ✓ J EPA/Other (JI f ] T v R j CiO L O M C1 L31 ^ 4 A c State ON rT. .. t It: T -s ^ EPA/Other +/ (AG LU d. State41 Z LU EPA/Other U LU V) J. Additional Descriptions for Materials Listed Bove K. Handling Codes for Wastes ListedAbove Z /J' a, b. `LU 1.i 8} ' ��QUER �`[-'INNE: jPAINT SLG.7GE 09: AC�C4 SPA, r 01 , f r;,5 .i - f' C. d. r, a „w Z 15. Special Handling Instructions and AdditiQInformation 0 aI116) AP#., 6329-�-AP# Q GLOVES, GOGGLES a PRO C 'ING Z EMERGENCY CON` CT: CHE TREC 1•-8C� 4-9300 LUERi#o �' 1S}128 ' 16. GENERATOR'S CERTIFICATION: I hereby eclare that the contents oflhis consignment are fully and accurately described above by proper shipping name and are classified,packed, Umarked,and labeled,and are in all resp is in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quantity generator,I cerci that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically CL practicable and that I have selected the p acticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health N and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is ci�: available to me and that I can afford. OPair ted/Typed Name Signature y i Month Day`/ dear/ J A m LU T 17. Trans orter 1 Acknowled ement of Receiptof Materials l J URAMonth Printed/,T,pad Name - '~ Signature r onay y Is 8 18. Transporter 2 Acknowledgement of Recei of Materials /f TPrinted/Typed Name Signature Month Day Year w E � R V19. Discrepancy Indication Space Z F A C I L 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by his manifest exce tas noted in Item 19. T Printed/Typed Name Signature Month Day Year DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. 22A (1/99) (Generators who submit hazardous waste for transport out-of-state, 80 97022A produce completed copy of this copy and send to DT5C within 30 days.)