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amental Protection Agen9y 11 jam' ro.2050-0039(Expires 9-30-9 ) See Instructions On back Of page b. Department of Toxic SQ!f.. neek rol -�Form designed for use on elite(1 -pitch)yr —ter. Sacramento, rnia 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 law. WASTE MANIFEST of 3. Generator's Name and Mailing Address A. State Manifest Document Number Fr�rr;•Ftt 44668130 er! }�4G �n,, ;�t Q T7 R7f O r➢t)f C1! Csti'.Qa? B. State Generator's ID LO LO ,r�,t:• :::a'. �� A. Generator's Phone ( jq� aCV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] co PACIFIC t.C+Aa! U ' y C7 l4 K°� �+ '� c, ," c O L.M1 f,f r.: !� D. Transporter's Phone O 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) w/Q F. Transporter's Phone ' V 9..Desi rated FacilitM]�ame and Si a Addre 10. US EPA ID Number G. State Facility's ID PAC-3 -1C RE.,tUURCE �'E!:G EPiI' C A Doe S 2 5 2 4O a .Q 315G, EAST PICO BLVD. i d LOS ANGELES, CA 90023 P' f fl 0 0 S c 5 2 4s Q g, H. Facility's Phone 0300? 499..^7146 htQ12. Containers 13. Total 14. Unit V 11. US DOT Description(including Proper Shi ping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number Z �?N14 States. _ 4_ ~ "r TPA er EOt G - - -- - -�.--E! w 0E Ryb' WasPaint Related Material. 3, UN1263o PGII stare 214 00 E Dt 'J1} V R r} I^.!"'/1 EPA/Other D1. CN A n / State R �'t3o't�i E--r!r�F?f i e EPA/Other-90E LU d. State UEPA/Other w N J. Additional Descriptions for Materials Listed Bove. K. Handling Codes for Wastes Listed Above O -- fw� Llrl�r.•- i� °^ Itii1M- R:aet rr�e -- a. b. V) -r"�Z?D .. f F �.�..5 k.taWEF S 1f�l ER PAINT Si.'UD E ADD E A- F 002. .FW3' !� ,�5 �. x . d. Q ' Z 15. Special Handling Instructions and Addition I Information O - -s-1-j--iti �4Er3 � Z.1.E0 A fs# 6 3 2 9-i-?�-�-'•,r�.;;*-GLOVES, GOGGLES & IoRGT LT��/E CLOTHING Z EAr—RISENC`r' CONTACT: CHE TREC ;L_.$01--'429-93�CiC LU ERC,#Y -fF,� 11B) .GL� _. 16. GENERATOR'S CERTIFICATION: I hereby eclare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Umarked,and labeled,and are in all respec s in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quantity generator,I certifythat I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically a practicable and that I have selected the r cticable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health and the environment;OR,if 1 am a small c uantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is W available to me and that I can afford. OP,rl'nted/Typed Name Signature Month Day Year Z tL T17. Transporter 1 Acknowledgement of Receipt f Materials ---�' Month DayYear w p Print / d Na/JmL Sial atyre // / WS \_./ ,7'Z, /C�j/e„j^ Com: -' /� tr �'� l'•". Jf_fyf�t- '� i�•�'.t'.r i 4 LL_ 0 18. Transporter 2 Acknowledgement of Receipt f Materials - O T Printed/Typed Name `-` Signature Month Day Year N E Q R U 19. Discrepancy Indication Space Z F A C I L I 20. FacilityOwner or Operator Certification of cei t of hazardous materials covered b this manifest except as noted in Item 19, T Printed/Typed Name Signature Month Day Year Y DO NOT WRITE BELOW THIS LINE. DTSC 8022A(1/99) Yellow: GENERATOR RETAINS EPA 8700-22