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Please pct p& Form designed for use on elite(12-pitch)""typewriter.) Form App?oved.OMB No:2050-0039 <br /> ORM HAZARD(SCjS 1.Generator ID Number . ;" 2 Page 1 of 3.Ems Response Phone �¢ 4.;Manifest Tracking Number <br /> WASTE IVIAFEST CALee@34158715i Ka <br /> 49940 d J J <br /> b 5 Gemirator s Name and Mailing Address Generators Site Address(if diffe,an ttha,mailing address) <br /> ADESA CALIF.DBA.:ADESA G0LD'td GTE <br /> 16501 GTANFO D <br /> Generators Phone: A <br /> T6ACY 95 <br /> - Ai�2®9-6393934 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Na U,S.EPA IP Number <br /> 8� 1 �F IityName/andSiieAddress=.<.- U.S.EPA ID Number <br /> PACIFIASTESOURRCEELRECOVERY SERVICES _ <br /> CAD $24�a <br /> LOS ANGELES., CA 90023 <br /> Facilitys Phone: (8 00) 499^7145 <br /> 9a; 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11. <br /> HM and Packing Group(if any)) Total 12.UnitNo. Type Quantity Wt.Nol. 13.Waste Codes <br /> WASTE PAINT RELATED MATERIAL, <br /> o 1PGII RQ, (D001) a <br /> r- DM G k <br /> aq <br /> HAZARDOUS <br /> - _ <br /> CLEANING SOLUTION d <br /> (CALIF2N: A REGULATED p . <br /> ONLY.) Y <br /> 3. <br /> 4. <br /> 44; <br /> 14.S pecial Handling Instructions and Additional Information <br /> 9b2 ) AP- 532.$ 9b2) AP 6339 <br /> CLOVES, GDGGLES & PROTECTIVE CUTHING 24HR EMERGENCY CONTACT:, KIRK WALDORF <br /> ERGO: '9b1)-.12$ 9b2 NONE <br /> TRAN$POR'TE 1. PNON 1 '8889 S3-13481 II 1111.. I !I I III 1 111 1111 IN 11111111 <br /> 15. GENERATOR'SIOFFEROR'$CERTIFICATION, I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified acka ed <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 a small quantity generator)is true. <br /> Generatcre Off or rintedlTypedNa t�. Signature <br /> Irk! <br /> -i 16.International Shipments <br /> ❑Import to U.S. ❑ <br /> Z Export from U.S. Port ofentry/exit: <br /> — Transportersignaiure(for exports only): Date leaving U,S.: <br /> Ix 17 TransporferAcknowledgment ofReceipt of Materials <br /> IU <br /> 1ia0 Month Day Ye <br /> Transporter 1 PrintedNyped Name e i Signature <br /> U) <br /> Transporter 2 Printe ped Name Signature Month Da Year <br /> 18.Discrepancy , <br /> )- <br /> 18a.Discrepancy Indication Space s <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 4� <br /> • f„ r <br /> , <br /> 18b.Alternate Facility(or Generator) Manifest Reference NumbeU.S.EPA ID Number <br /> J <br /> .1' Facility's Phone: <br /> W IBe.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 19.Hazar ous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1 2. 3. <br /> 7- <br /> 4. <br /> 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except asnoted in Item 18a <br /> Printed y d Name, o Signatu Month Day Year <br /> PA Form 8700-22(Rev.3-05) Previous editions are obsolete, DESIGNATED Face 1Tv Tn rchYcowT.,n <br />