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Please print or type. <br />7,it <br />M HAZARDOUS 1. Generator ID Number <br />E MANIFEST C A L(Jki Z <br />5.2:31 <br />or's Name and Mailing Address <br />OKS 800Y SHOP <br />MOFFAT BLVDTECA, CA 45536 Phone: ?09 82.3_.4452 <br />er 1 Company Name <br />1FIC RESOURCE RECOVERY SERVICES <br />er 2 Companv Name <br />o uesignateo racuity Name and Site Address <br />"ACIFIC RESOURCE RECOVERY `;FRVICES <br />1150 EAST PICO BLVD. <br />OS ANGE' l F s, CA QW23 <br />Facility's Phone: (OW) 499-714, <br />9a, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class. ID Number, <br />HM and Packing Group ('if any)) <br />tY <br />w <br />Z 2NON R RA HALARU US AS LIt�UIQ 4! <br />0 CLEANING SOLUTION) <br />GLYCOL) (CALIFUfiNIAWREGULATED1ONLY) <br />2. Page 1 of 3. Emery Res "- ponse Phone 4. Manifest 1 <br />1 -H0 -i;02 <br />-7145 <br />Generators Site Address (if different than mailino arlri <br />10. Containers <br />No Type <br />! I DM <br />Form Approved. OMB No. 2050-0039 <br />30 JJK <br />U.S. EPA ID Number <br />U.S. EPA ID Number <br />`,24W5 <br />l <br />12. Unit <br />Wt.Nol. 13. Waste Codes <br />Wi) ANN 6395 9b4) AP# 6402 <br />GLOVES. GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTAGi: k7.RK WALpORF <br />E'"# �b `)--1.34-9b2) NONE 9b3) NONE 9b4) NONE <br />T�'ANSi�nRTF�� , ,, i,;,,�- IIIIIIIIIIlI►illIIlllilllllliNllllllllllilliililllJill <br />6 1 4 7• r:itr<.. , j ,....1,34,. <br />15 GENERATOR'S/OFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above b the Proper shipping <br />marked and labelediplacarded, 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 EPA Acknowledgment of Consent. y P P PPing name. arc! are classified, packaged. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity generator) is true. <br />3eneralorslOfferors Pnnted/Typed Name <br />Signature <br />I Month Day Year <br />J16. International Shipments <br />�' ❑ Import to U.S. <br />? Transporter signature (for exports only). <br />tY 11. Transporter Acknowledgment of Receipt of Malenals <br />UJ <br />X Transposer 1 Printed/Typed Name <br />❑ Export from U.S. Port of entry/exit: <br />Date leaving U.S.: <br />Signature <br />18. Discrepancy <br />185. Discrepancy Indication Space <br />❑ Quantity ❑ Type <br />❑Residue ❑Partial Rejection <br />r— <br />18b. Alternate Facility (or Generator) Manifest Reference Number: <br />J <br />U <br />U.S. EPA ID Number <br />Facility's Phone: <br />w 18c. Signature of Alternate Faty (or Generator) <br />F - <br />Q <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous <br />LU 1 waste treatment, disposal, and recycling systems) <br />� 2. 17- <br />4. <br />7— <br />Ll20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed(fyped Name <br />Signature <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. <br />Day Year <br />Day Year <br />❑ Full Rejection <br />GENERATOR'S INITIAL COPY <br />