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�}lease br� e. Form designed � � . p' igned for use on,elite(12- itch)_typewriter.) Form Approved.OMB No.2050-0039 HAZARDOUS 1 Generator 1D Number 2.Page 1 of 3;Emig Response Phone 4.Manifest Tracking Number V�1(;STEMANIFEST AL W 34687 1 1-�5 ��495- 146 10 JJK 5 Gendratoes'Na" andMallff", dtess' ""'�x 4: ` � � Generator's Site Address(if different than mailing address) A CALIF.I ADESA GOLDEN GTE 18,501 STANFp RD TRACY,- CA Generator's Phone: Y"S N209^-8393934. 6.Transporter 1 Company Name U.S.EPA ID Number PACIFIC RESOURCE RECOVERY SERVICES CAD008262405 7.Transporter 2 Company Name U.S.EPA ID Number 4 8.Designated Facility Name and Site Address U.S.EPA ID Number RACI:FIC RESOURCE RECOVERY SERVICES CAD 5262405 3150 EAST PILO BLVD, LOS ANGELES, CA 90023 Facility's Phone: > "' (8 00) 499-7146 9a. 9b.U.S.,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM 'and Packing Group(if any)) 13.Waste Codes No, Type Quantity Wt.Nol. X 1•UN1263, WASTE PAINT R" , o PGII, RQ, (D001) / ON (_� G. z 2•NON.RCRA.HAZARDOUS WASTE LIQUID (WATERBORNE CLEANING SOLUTION) '(CALIFORNIA REGULATED DF � G 4. 14.Special Handling Instructions and Additional Information 9b1) APO 6325 9b2) AP0 6339 GLOVES, GOGGLES A PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: KIRK WALDORF ERG#: 9b1) 12.5 9b2) NONE. TRANSPORTER- I PHONE # 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,and are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent; 1 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)Is true. ratorslOfferor, Printed/ryped Name Si ure ti c le t�� 4 Cts oR , / ear, ..r 6.Intemafional Shipments `f! ite. ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S W 17.TransporterAckd wledgment of Receipt of Materials R Tran er P ted/Typ ame natur a. col Transporter 2 Printed/Typed Name re Month Day Year H 18.Discrepancy Ir 18a.Discrepancy Indication Space El quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection _- Manifest Reference Number: 18b.Alternate Facility(or Generator) ' U.S.EPA ID Number c LL Facility's Phone: . w 18c.Signature of Alternate Facility(or Generator) Month Day Year r~ z N19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) D 1' 2. � 3' 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in item 18a Prin yped Name Sign reMonth Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR