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Form Approved. OMB No. 2050-0039 <br />F icaoc <br />pill n Ui iyVc. <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />�G�JC y2 l <br />2. Page 1 of <br />3. Em y Response Phone <br />4. Manifest Tracking Number <br />019535540 JJ K <br />WASTE MANIFEST <br />� <br />I$00--499 <br />-7145 <br />5. Genera is Name and Mailing Addr ss Generator's Site Address (if different than mailing address) <br />fs = r,Zk4`-� �i---r52 P/3/f y1� <br />j� FPC 7o4f7` 1 ::, <br />r'k y.� c ,�,� ��� Z 3 i <br />Generator's Phone: <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />CAD008252405 <br />PACIFIC RESOURCE RECOVERY SERVICES <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />CA0008252405 <br />PACIFIC RESOURCE RECOVERY SERVICES <br />3150 EAST PICO BLVD. <br />LOS ANGELES, CA 90023 <br />Facility's Phone: ( 800) 499--7145 <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./Vol. <br />MAB S, ORGANIC, N.0 -S, <br />- <br />p <br />w <br />z <br />X <br />, _ <br />w <br />3NON RCRA HAZARDOUS WASTE SOLID B <br />DM <br />P <br />4t4OW D _.(WATERBORNE <br />J#C9.�_SpLUT11)•pl4-.4.CALIF-0R*1 R-GUL-ATED <br />14. Special Handling Instructions and Additional Information <br />9 b 3) 6 402 9b-4-}--ftP*"6-O9 <br />rLWVEr7GZ0ZrGLjEST&PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: KIRK WALDORF <br />ERG- # - 9b1 333 9b2 1-2-6 9b3 )NONE <br />TRANSPORTER I PHONL # 1-888-213--1348 <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, arca 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 />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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.i e. <br />eners/Offer is P inted/Typed flame ignatur y Mon Day Year <br />Lao/ <br />-i16. <br />ipments <br />❑Import to U.S. Export from U.S. ort of entry/exit: <br />� <br />FE <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials Af <br />LU <br />a <br />Transporter 1 Printed/Typed e Signature �ona Year <br />Z <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />I- <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />>- <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J_ <br />U <br />LL- <br />Facility's Phone: <br />w <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />2-J <br />1 <br />2 <br />3. <br />4. <br />20. Designated Fa�lity Owner or Operator: Ce 'fication of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Ty N e _ j / Signature Month Day Year <br />WJ��V/ ]Ja- <br />A A rr(►T L►V[�T �■ <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. UtJIUNA I tU rHVILI I T I v Cr h b t:-IY1MnirGo i v i %a i Lai <br />