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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 7 1215 1 (800)424-9300 017 7 9 2 4 7 7 JJ K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if 6rcrent than mailing address) <br /> CERTIFIED COLLISION CENTER, <br /> 7710 MURRAY DRIVE <br /> S i�rGKTt)N CA 95210 <br /> Generators Phone: 209 630-0300 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DEMENNO J KERD0014 <br /> 2000 N.ALAMEDA STREET <br /> COMPTON Cry. 90222 CAT080013352 <br /> Facility's Phono: (31Q)53rt <br /> 00 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10-Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)} Na. Type Quantity Wt./Vol. <br /> 1 UN1993, FLAMMABLE LIQUID, N.O.S..(PETROLEUM DISTILLA ES), 3 t <br /> Dflt71 F D018 343 <br /> PG II DIM G <br /> z 2- <br /> w <br /> C7 <br /> 3 <br /> 4. i <br /> { <br /> 14.Special Handling Insductons and Additional Information <br /> EMERGENCY CONTACT:CHEPATREC 1-800-424-9300 WOES TERMINAL:CERES CS PROFILE#3131:100417-04 PAINT <br /> THINNER * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT ? 1� 1xC — <br /> '15. GENERATOR'SfOFFEROR'S CERTIF1CATtON: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and daare classified,packaged, <br /> marked and labetedlplacarded,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 terms of the attached EPAAcknowledgme of co <br /> I certify that t waste minimizations ement identified in 40 CFR 262.27(a)(rf I am a large quantity or r(b m quantity generator is true- <br /> Gene tor's[Offerfel Printedrryped Name gn to Month Day Year <br /> a14 62- 1 AP <br /> .-+ 16.International.Shipments <br /> F— Import to U.S, ❑Bipart from U.S. Po �t <br /> E Transporter signature(for exports only): Date leaving U.S.: <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> Lj <br /> Trans P- ted1T ed Na.a Signature Month Day Year <br /> N V0� oma( 02 !P <br /> Q Transporter 2Printeafry ed lame Signature Manth Day Year <br /> � r <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity 1:1 Type ❑Residue ❑Portia!Rejection ❑Full Rejection <br /> Manifest Reference Number- <br /> F— <br /> umberF— 16b.Alternate FaclRy(or Generator) U.S.EPA ID Number <br /> U <br /> L Faciliys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> cn 19,Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1. 2, 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Farm 8740-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />