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rN <br />ti f 0 <br />0, <br />W, <br />MI <br />" , ,type,- F n 0 <br />(qrA"design�kqfbruson..Oie,(12-pj�qb) <br />ty writer.) Form Approved. OMB No. 2050-0039 <br />ILINII O til HAiARDOus 1. 13tierato bt7 <br />2. Page 7 of <br />3. E e y Response Phone <br />4. Manifest Tracking Number <br />0WQ—SM <br />CALOOM95861 <br />I <br />I 9-73 <br />-49.46 <br />4548524 JJK <br />Generator's Site Address (if different than mailing'address) <br />A9 RICAN AUTO BODY <br />2347 MAGGIO CIR <br />LORI, CA 96240 <br />Go Phone:209 334-62a2 <br />6. Transporter 1 Company MM, a U.S. EPA 10 Number <br />PACIFIC RESOURCE RECOVERY SERVICES 2 CA <br />_poRo_;! <br />T Company Name U.S, EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />CAO0082-62406 <br />3150 EAST PICO BLVD. <br />LOS ANGELES, CA 90023 <br />Faclill es Phone: (800) 499-7145 <br />ga. <br />9b. U.S. DOT Description (including ProperShipping 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 />JI . tWASTE <br />FLA14MABLE SZJLIDSj, ORGANIC <br />N.-O.S.'(ACETONE), 4.1, PGII, RQ,(0001), <br />79"2- <br />12 <br />DM <br />//0 <br />P <br />2UN12 aRf-SIOUE LAV tONTAINED VAINT_!"��U <br />1001 <br />T 77 <br />MATERIAL', S.-PGII <br />OM <br />06 <br />P <br />N MA RAZAPMOUS Wi I E <br />4"Alg�) (CALIFORVA RMU"LA"TE'DONLY) <br />epi or 15,_ <br />OM <br />G <br />14, SpeciaFHandling Instructions and Additional information <br />9b1) AP# 6334 9b2) 633e 9b3) AP# 44" +bllt-efte— <br />GLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: WJLDORF <br />E1RG#;:1b1 133 9b2 ) ,110,111, (IRI <br />128 9b3 NONE-9b4+—Q44- 1111111111111111111 till <br />11 <br />TRANSPORTA I PHON # 1--888 —2 13-1348 <br />j <br />15, GENERATOR'SIOFI EIROIR'St9ftTIFICATION: 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/placard6d, and are in all respects In proper condition for transport according to applicable international and national governmental regulations. tf export shipment and I am the Primary <br />Exporter, I certlfy,Iftpt the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />PrInte'7 /TypodNarrie ',N Sig lure Month Day/ Year <br />7etatoe7hfferors <br />1 V <br />1Writdirtfaffohayhlorrilhills Import to U.S. F Export from U.S. Port of entrylexit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />,T sportetAcknoMOdbmentofReceipt ofMaterials <br />117�pn <br />Trans "` PrintetllTypad Name ur Month Dayt Year <br />Z <br />Transporter 2'PrintsidifTyp6d Name Ailindlure Month Day Year <br />18. Discrepancy <br />18a. Discrepancy Indication SpaceFull Rejection <br />0 Quantity 0 Type 0 Residue 0 Partial Rejection F <br />Manifest Reference Number: <br />18b: Alternate Facility (or Generator) U.S.EPAIDNumber <br />Facility's Phone: <br />w1 <br />8c.'Silinatuteof Alternate Facility (or G;nerator) Month Day Year <br />Waste Report <br />19, Hazardous Mainiggement'Method hazardous <br />ardous as (i.e., codes for waste treatment, disposal, and recycling systems) <br />stems) <br />2. <br />3. <br />4. <br />ilesl nat1d �eroOperator. a tor Certification hazardous materials v!rpq b4 the maniflest,except as not6d in' Item 18a <br />r <br />Whih --Day Year <br />ur-01UNMI r_u FACILITY I I U ur-114ir-nmil Uri <br />