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Please print or type.(Form designed for use or elite 12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking plumber WASTE MANIFEST JJ K- 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) -;: RTIFIEO COLLISION 710 MURRAY S"I"OCKTON, l 95210 Generators Phone: 478"-9971 6.Transporter 1 Company Name U.S.EPA 0 Number :E RECOVERY SERVICES 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPR ID Number _COVERY SERVICES nNGELES, CA 40023 Faclity's Phone: (800) 499--7145 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes MM and Packing Group(if any)( No. Type Quantity Wt,/VDI. o atill, RQ' (u00:L) Z 2, 'QN RCRA HAZAl W S Utt3 i t LU CLEANING SOLUTION) (CALIFORNIA REGULATED ONLY) 3. 14.Special Handling Instructions and AddiVonal Information �� CLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: KIRK WALDORF :: cANSPORTER I PHONE #01-888-2i� q�S,.�r�d�t llllllllllllilli[lllllllllllllll!llllllllllllllllllllll 15. GENERATOR'SIOFFEROR'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 labeledlplacarded,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 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 identified in 40 Cl 262.27(a)(if I am a large quantity generator)or(b((€fl am a small quantity generator)is true. Generators1Offeror'sPrintedlTypedName Signature Month Day Year .rj18.international Shipments i-- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: 'M Transporter signature(far exports only): Date leaving U.S.: Ix W 17.Transporter Acknowledgment of Receipt of Materials qTransporter 1 Printedfryped Name Signature Month Day Year CL Transporter 2 PrintedlTyped Name Signature Month Day Year i` 18.Discrepancy 189.Discrepancy Indication Space Quantity El Type El Residue ❑Partial Rejection ❑FUII Rejection Manifest Reference Number: H 18b.Altemate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: Lu18c.Signature ofAltemate Facility(or Generator) Month Day Year a 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 3. 4. 20.Designated Facllty Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in item 182 Pdntedlryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR