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Pr0i---tips.(Form designed for use on efit.-, <br /> Fonri Approved.0101B No. <br /> UNIFORM HAZARDOUS I Genet ort Numaer 2.Pne I of13.Emergency Response Ph,�Ijo. 4,Kinifest I ' <br /> ing N ibe, <br /> WASTE MANIFEST <br /> 1916-371-5747 01814 4622 JJK I <br /> —wc, uvrmm- t""'WIA 6=0'14 Of It'VI itlaiiing a4drass, <br /> 0 1L CI:).-3-TO C1,;71 Cit-I <br /> a loez("h-,ri. 6004-55 1-gas <br /> i:a1isavit-af I Compally Name <br /> "AOS EN"ARONMENTAL iERXICE-3 INC. U.S-EPAI(Dmmwr <br /> U.S.FP11U Numba, <br /> 0.Lj�'SV'Ialp I 3'14y Ilatris and Sil-3 Addrc!s <br /> PACIFIC RESOURCE RECOVERY U.S.EPA 0 Kt; G-r <br /> 31--Ij FA Sc T FICO e r rvye-�!�. <br /> 1P <br /> rrw <br /> LOS A14 =S.C;, qr <br /> kaccih's Phwa:BOG-499-7145 I I <br /> .1. 9b U.S.)0T (indtidhq?roper SH-ving Name,Flazara Class.ID Numta,. I-fs I <br /> ill,C TO FI 12.LIM <br /> Hid and P--hinq C4(-Jj)fif any)" <br /> No. 13 %K3 S�C'C <br /> Type I <br /> UN1203,WASTE GASOLINE,3,PGII <br /> G1 owl 0018 <br /> P14. <br /> I <br /> at <br /> 14 S;vcjaI!janafrq Instructions a al!nfowia(ion <br /> selip 01FILEWMM-37 ERG#128 <br /> E.R. COWRACTOPt RAMOS EiVv1Ra4W=—jqTAL <br /> RAXOiI`:-:RS SHOULD BE Tr-AN-JE-3 AND USE AF-JoffOVED PPE <br /> -7 <br /> /- <br /> 1115. GE4EPATWIhOFF---RO"CERtIFICAnON: Firg nam_141 ane—67svilled,packaged. <br /> 11gly wst <br /> , <br /> c"36reanj labafattpfaw--&d,znd ora in illi nm; c.,fvrK Cwaw for Ivir-sprAi w-rAl"To to JPPk;4?Ik(Itarpatictfiff ann 11alowi tivolmn-AM41 q-'t-v 11irrnw;l IM I;,!in lfw Pike(Y <br /> 40 CFR ryuto;ly'J"twvloll I "144 <br /> 'Genw.-wvVfit-;f' Pd `rMyp ..1w, <br /> Sig u <br /> Month Day year <br /> Export from <br /> El inwi'.0 U.S U.S. Frilry/exil: <br /> Tfansprifiar sigriature(for exports only): Date leavbxj U.S.: <br /> UJI 1 Trwpanef Acknowtedgmen'.oi.'Receipf of PUlerwals, <br /> nritc, <br /> 0 Signal Uay Y41f <br /> CIL <br /> 00 <br /> �I firnnstioner 2 Pnnteffl F-..pf.d ne <br /> am <br /> < 2 <br /> oigOure Month Day�j11'(car <br /> anal <br /> 011 2r' <br /> I&I DiSt'Op3KY Indication Space <br /> El Quamo, ❑ <br /> Type MR sirue D I'Mial Rejection ❑ <br /> ?u!1 <br /> Manifest Reference Number, <br /> j=!13b.Afteiviair-F.,ce.it y for Gcneralor) <br /> U.S.EPA 10 Numb <br /> L<� Facility's Phone: <br /> 1;,, ignahas of Facility's <br /> iie <br /> Facility lar Gaveracr) <br /> 'Allow lby <br /> 65 M.Hwk�dous'ftsle ReportMamigement Method Codes(i.a,cedes for trealine"It,dispoiffi,arc recyclingsystems) <br /> o <br /> 2. I3. f4 f <br /> 20.D!Ogmtled Fa,61;vl Ormer(;r Operator:Ceniffea(iin cl rr-Pl Of hazardous rp-31afids covered by the manifest except as in item 180 <br /> ';n—ntaZy-pea ia!7 <br /> Signature <br /> I I A'� <br /> A POO;-Mu-1 1�s <br /> EPf,Form 8700-22;'Rev.3-05)) Previous editions are obsolete. <br />