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Please primo r pe.-(Fo>m designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0038 <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 1 2 13 1 800 4249300 01817 0 2 8 8 J J K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> CERTIFIED COLLISION CENTER <br /> 7710 MURRAY DRIVE <br /> STOCKTON CA 95210 <br /> Generators Phone: 209 478-9971 <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CA D 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S!EPA 10 Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> PACIFIC RESOURCE RECOVERY <br /> 3150 E. PECO BLVD. <br /> LOS ANGELES CA 90023 CAD008252405 <br /> Facilty's Phone; (%1W)49S71 45 <br /> ga_ gb.U-S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HIM and Packing Group(if any)) No. Type Quantity WtNol. <br /> 0 1.UN1325.WASTE FLAMMABLE SOLIDS.ORGAINC, N.O.S..(PAINT pool 359 <br /> us <br /> K SOILDS/DEBRIS).4.1.PGII D M _ ZQc) P <br /> 2'NON-RCRA HAZARDOUS WASTE,SOLIDS(WATERBORNE 2 <br /> SOILDS/DEBRIS) b M oa P <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CkEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#91131:133,982:171.A41iO LE#B <br /> 9Pa:1-090067 PAINT SOILDS/DEBRIS,9132:190-00080 WATERBORNE SOLI D PS _08] � * .PP PRI •�? E <br /> {._:. <br /> 15- G N ERATOWS10FFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described,above by the proper shipping name,and are classified,packtaged, <br /> ma*ed and.labeledlplacarded,and are in all inspects in proper condition for transport according to applicable international and national govemmental regulations.H expott'shipment and 1 am the Pdm* <br /> Expanter,I certify that the contents of tlt s consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I gprtifyfhat.the waste rtlitgm,ation statement identified in 40 CFR 26227(a)'(if I am a large quantity ganterator)or(b)(if I am a small quantity generator)is true. <br /> nffpmes P ntedli_y ed1lame Si re {�n - Month Day Year <br /> C41 <br /> 16.International Shipments <br /> ❑.importto U.S. ❑aport from U.S. Part of entryle* <br /> F` <br /> z Trans er signature(for exports only):' Date leaving U <br /> 17-T.r-_�spn_derA&novv!e�+� Pro of Receipt of Materials <br /> Lull <br /> Trans 1 Print yped s Signature Month04y.._1Ift- <br /> -6, K=,-_ I (-*I W, <br /> r f <br /> Transpoder 2 P7intedtr0'ijName Signature Month Dai` lea <br /> 18.Discrepancy v <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate Facility(or Generater) U.S.EPA ID Number <br /> a <br /> Facifitysphorte: <br /> C3 18c.Signature of Alternate Facifity(or Generator) Month Day Year <br /> d � <br /> x I <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,-codes for hazardous waste treatmertt,disposal,and recycling systems) <br /> G f. 2. 3. 4. <br /> 20.Designated Faality Owner or.Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 16a <br /> Printed(fyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />