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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Farm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number - 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 71213 1 (800)424-9300 018237864 JJ K 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) CERTIFIED COLLISION CENTER 7710 MURRAY DRIVE STOCKTON CA 95210 Generators Phone: 209 830-9300 8.Transporter 1 Company Name U,S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 3 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA iD Number DEMENNO/KERDOON 2000 N.ALAMEDA STREET COMPTON CA 90222 C,A T 0 8 0 0 13 3 5 2 Facility's Phone: (310)537-7100 ga. 9b.U.S.DOT Description(irciuding Proper Shipping Name,Hazard Class,ID Number, 1a.Containers 11.Total 12.Unit 13,Waste Codes HM and Packing Group(if any)) No. Type Quantity WLfvol. 1. NON-RCRA HAZARDOUS WASTE, LIQUID(WATERBORNE PAINT) 331 D M LS G — - z z. L 3. 4. 14.Speoial Handling instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#961:171 11 PROFILE#951: 426983 WATERBORNE PAINT * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT # ?z .&,� l ,16 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propershipping 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 terns of the attached EPAAcknowledgment of Cons I certify that the waste minimizatio tement ident Ted in 40 CFR 2$2.27(0)(if I am a large quantity generator)or(b) ' aa small quantity gene true. erorsPrinted/Type e g a Month Day Year -j 16.Intemational Shipments `t- ❑Import to U.S. ❑Expon from U.S. Port of entrylexit: Z Transporter signature(for exports only); Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials T a rte 1 Printe yped N e Signature Month Day Year w O t G Transporter rinte Ry Name Signature Month Day Year 1- 18,Discrepancy 189,Discrepancy Indication Space ❑ Quantity ❑ ❑ j ❑Full Rejedion ❑Type Residue Partial Re edtion Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U u�. Facility's Phone: LU 18c.Sigrature of Alternate 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) LU 1. 2. 3. 4. 26.Designated Facility Owner or Operator.Cer9catlon of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pr nted{Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)