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Form Approved,OMB No.2050- Pi ease print or type.(Form designed for use on elite(12 pitch)typewriter.) 2 page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number "ORM HAZARDOUS 1.Generator ID Number J J K .STE MANIFEST Generator's Site Address(if different than mailing address) 5.Generator's Name and Mailing Address _,B'S AUTO AND TRUCK;PLA7A. 14749 N THORIWON R.D. I:6rSS 'iv, x:32 Generator's Phone: U.S.EPA ID Number 6.TransporterI Company Name -; ��r'!IFr'3PIMEPiTbI S�p,ACEG rel('` U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Addres",AOS WARONMEWiskI SER''V10ES INS:- 1515 SOUTH RIVER RD. 'NLNS�T ACKWI=NT0,CA 95691 6-3'71-5747 Facilliy's Phone: 10.Containers 11.Total 12.Unit 13.Waste Codes 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No. Type Quantity Wt.Nol. HM and Packing Group(if any)) 1. O Z 2• W .. _ 3. 4. ( 14.Special Handling Instructions and Additional Information X j c 7;!,..._ . . f a R. (gin d,JTRAGIQP: FANIC;S F WYjR(3 WIYIeWI,�tL jANDLERS SHOUID, DE TIF4JED AiWD USE APFjRr:ik.•C-D PPF 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,package 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 1 am the Primary Exporter,l 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 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Month Day Generator'slOfferor's Printed/Typed Name Signature F- 16,International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Date leaving U.S.: Transporter signature(for exports only): W 17.Transporter Acknowledgment of Receipt of Materials 1 Month Day Transporter 1 Printed/Typed NamB --y� Signature 0 Month Day QTransporter 2 Printed/Typed Name Signature H 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑TYPe ❑Residue ❑Partial Rejection El Full Rejec Manifest Reference Number: U.S.EPA ID Number 18b.Alternate Facility(or Generator) J_ V ari Facility's Phone: Month Day W 18c.Signature of Alternate Facility(or Generator) Q � 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste 11 t11 r11 e 11 atm11 e 11 n11 t,disposal,and recycling systems) 4 201• i, ' 2. 3. r' 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Printed/Typed Name Signature --- w�n��.ueron CAt ll ITV Tri r;PNF