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A <br /> Please pri Type.(Form desig <br /> op elite ch ' ewr(ter.) Form Approved,OMB'No.2050-0039 <br /> 1 11_1ORM HAZARDOUS, Generator ID Number d' g ?tp Page 1 of I,Em Response Phone 4,Manifest Tracking Number <br /> " <br /> WA§A MANIFEST '° CAL 54005 f1*�3 499!,410D017002117JJK. <br /> n4? 5.G erators Name and Mailing Address t t Generator's Site Address(if different than mailing address) <br /> ADESA CALIFflDESA GOLDEN GTE: <br /> .. 18501 STANR[ <br /> TRACY,<CA 49377' <br /> i <br /> Generafors Phone: SAM 09-8393934 <br /> 6.Transporter 1 Company Name � ,� a U.S.EPA ID Numbe <br /> " 0, 1 a ns Pee ell;; <br /> 7.Transporter 2 Company Name ' U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address 1 U.S.EPA ID Number <br /> PACIFIC RESOURCE -RECOVVE�Y SERVICES - ..._ _ . _._... CAD $26240G <br /> 3150 EAST PICO BLVD. <br /> LOS ANGELES® CA 90023 <br /> Facility's Phone: <br /> (800) 499...- 714 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it;.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. , <br /> 1. ON_RCRA HAZARDOUS <br /> c CLEANING SOLUTION) (CALIFORNIA REGULATED 14 <br /> ONLY) G <br /> z 2 <br /> UJ <br /> 3. , <br /> For <br /> 14.Special Handling Instructions and Additional Information <br /> 9b2) AP# 6339 q <br /> GLOVES® GOGGLES & PROTECTIVE CLOTHING 24HR RG EMENCY CONTACTS KIRK WALDORF <br /> ERG.* 9b1) NONE 9 L : it 1118 I III III II III II !! I!I !II I!I !! I <br /> TRANSPORTE „I PHON 1-898 - t 3-734G a; <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 /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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,@ small quantity generator)is true. <br /> Generators/Offe rs P nledfryped N e Signature Month Da Year <br /> } 1 � O.Ale_ <br /> 107,1,/ f <br /> _I 16.International Shipments <br /> � EI Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): S Date leavin <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter er 1 Printedfryped Name Ff ,fSignature Month Day Year <br /> aTransporter Pdntedffyped Nam a Signature M QAth Day Year <br /> 18,Discrepancy <br /> 18a Discrepancy Indication Space 1:1 quantity ❑Type y�Residue ❑Partial Rejection Full Rejection <br /> Makfes ference No bar: <br /> 18b.Alternate Pacility.(or Generator) , U.S..EPA ID Number <br /> i. <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> Month,-,� Day Year <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> A <br /> 40601 <br /> 20.Designated Facility Owner or Operator:Certification of receipWf:hazardous materials covered by the manifest except as noted in Item 18a <br /> nntedrryped Name Signature Month Day Year <br /> l a _ ct <br /> E <br /> EPA Form 8700-22(Rev.3-05)'Previous editions are obsolej < 11CCIf_AI ATC11 CAf�ii tTV TA/�CAIC�ATA® <br />