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It <br />(f <br />loleas rtt, oe (Form desioned for use on elite M 2-niteh) tvnewriterl <br />N. r� <br />Form Annroved. OMB No. 2050-0039 <br />trN rorm 01uprc4 tnev, s-uol rrevious eamons are oosoiete. T Y*-, DESIGNATED FACILITY TO GENERATOVI <br />UN HAZARDOUS 1. Generator ID Number <br />2. Page 1 of <br />3. Erecy Response Phone <br />4. Manifest Trac g umber <br />NIFes�. cAL 95OEi1� <br />-5.499-7x45 <br />. <br />' JJ <br />5. Ge is Name and Mailing Address " Generator's Site Address (if different than mailing address) <br />ERICAN, .AUTO BODY , <br />2347 MAGGIO CIR <br />LODI, CA 95240-'h <br />Y <br />Generators Phone;- 209 334,-5289 <br />6. Transporter 1 Company Name <br />U.S. EPA ID Number <br />PACIFIC RESOURCE RECOVERY SERVICES <br />CAD 8252405 <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Designated Facility Name and Site Address <br />U.S. EPA ID Number <br />. CIFIC RESOURCE RECOVERY- Sf°RVICES . __ __.. <br />CAO008252405 _. <br />3150 EAST PICO BLVD. <br />LOS ANGELES, CA 90023 <br />Facility's phone: () 499"""7145 <br />I <br />ga" <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />Z <br />ZION RCRA HAZARDOUS E LIQUID L <br />UJ <br />(CALXFORNIA REGULATED ONLY) <br />ON <br />G <br />A HA24RODUS WASTE <br />GLYCOL) (CALIFORNIA REGULAT 0 ONLY) <br />Dil <br />CLEANING SOLUTION) (CALIFORNIA REGULATED ONLY) <br />PPI <br />14. Special Handling Instructions and Additional Information <br />9b2) APO 6336 b3) AP# 5395 9b4) AP# 5339 <br />GLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: KIRK WALDORF <br />ERG#:b2 NONE 9Wb NONE 9b4) NONE <br />TRANSPORT R 1 PHON # 1- 888 --2213-1343 <br />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, <br />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 I am the Primary <br />Y :.<EISP�[te� I "y( that a contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent <br />I cedify that the waste mini mlzzation statement identified in 40'CF� 262, aj (f I amaTarge quanfl generator) or (b)'(if I k a'smaltquantity'generatot) is true. <br />Printedff ed <br />a e signature <br />Month Day I Xpr <br />Ttoeqiroes <br />—J <br />r- <br />16. In ma i na Shi ents <br />❑ Import to U.S. Export from U.S. Pod of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />LU <br />17. Transporter Acknowledgment of Receipt of Materials <br />O <br />Trans rinted(fyped N Suture•' <br />M nth aye r <br />MIX//�� <br />Transporter 2Pdnted/Typed Ngme SI a re <br />s. <br />Month Day Year <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue <br />El Partial Rejection <br />EI.Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) <br />U.S. EPA ID Number <br />J_ <br />U <br />ua <br />Facility's Phone: <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />1. <br />2. <br />3. <br />4. <br />Ll�� <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />r 9 a a"hte -. —,_ - —" ��, � � " S gnat a <br />1"all <br />Month . Day Year <br />I <br />trN rorm 01uprc4 tnev, s-uol rrevious eamons are oosoiete. T Y*-, DESIGNATED FACILITY TO GENERATOVI <br />