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€3..rSC. 4G408. 0148 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> it <br /> n <br /> UAiFBRI ;IiI ARDOUS 1.Geamb 2.r ID NumPage 1 of 3.Emergency Response Phone 4.MaMfest Tracking Number <br /> "'WASTE MANIFEST CAD981640154 1 1-800-424-930® 3 • JJ <br /> S.Generarors Name and Mailing Address Generators Site Address(if different than mailing address) <br /> DON'S BODY REPAIR <br /> 1937 N. WEST LANE <br /> STOCKTON, CA 95205 <br /> Generators Phone: 209 464-3404 <br /> 6. �P 'g <br /> Tr�rsMoCrte�lCompa`ONOT LACQUER U.S.CA M52405 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> oe��na i� <br /> a. PACiFIiC NRES RCE RECOVERY Us A'$ 252405 <br /> 3150 EAST PICO BLVD. <br /> LOS ANGELES, CA 90023 - <br /> Facilitys Phone; (800) 499-7145 <br /> go."' 9b.U.S.DOT D (including Proper Shipping Name,Huard Class,ID Number, 10.Contains 11.Total 12.Unit 13.Waste Codes <br /> HM' and Packing Group(W any)) No. Type Quantity VVt.Nol. <br /> s s <br /> IX 1'PGII, RQ, (D001) ON0? G <br /> � <br /> Z 2. P 9 P <br /> iLU <br /> Y •F 4*1 <br /> !. <br /> AL- <br /> to <br /> A <br /> 4. <br /> V' <br /> 14.$4aal rdietg tesbust(p2g d I Info ti <br /> An <br /> GLOVES, GOGGLES & PROTECTIVE CLOTHING <br /> ERG#: 9b1) 128 <br /> TRANSPORTER 1 PHONE # 1-800-752-1566 <br /> 15. GENERATOWSIOFFEROR'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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and i am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the temns of the attached EPAAcknowledgment of Consent. — •, <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a targe quantity generator) (b)(if I am a ntity generator)ihytrue <br /> era s/Ofremes Pd yped Name Signa re .Mont j)ay Y7 <br /> GK KC�U j <br /> —a 16.international Shipments <br /> tL ❑Import to U.S. ❑Export from U.S. Port of entry/ ' <br /> z Transporter signature(for exports only): Date lea U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transpo yped Name natu n Day Year <br /> Transporter 2 Pdnted/Typed Name aldre Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ®Type ❑Residue ❑Partial Rejection ❑Fut Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Numb <br /> J <br /> r`ti Facilitys Phone: <br /> LL, 1Sc.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> a—i 19.Hazardous Waste Report Management Method Codes(i.e.,des for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated Facility Owner or t)perator.Certilloation of receipt of hazardous materials covered by the marrifestexcept as nod Nftarn 18a,o-- <br /> Pri ' yped Name, Swiftre Day Year <br /> EPA Form 8700-22( ev.3-05) Previous editions areobsolelta ESIGNATE0 FACILITY TO GENERATOR (IF REOUIR <br /> 10314.0409 <br />