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a on elite`(12-pitch)_typewriter) Form Approved,OMB No.2050 0039 <br /> ,rator ID Number 2r Page 1 of 3.Erne ency Response Pftone 4,Manifest TrackingNumbor <br /> CAL 4I <br /> 0 S164,70 JJK <br /> vAddress�• Genefatbr s;S a Address(if tliffenmt thanimailing address) <br /> O9A,"AOESA-,GOLDEN OTS <br /> aFOI� R� <br /> ompany ame <br /> U.S.EPA ID Number , <br /> C '.R St91l:.RECOVERY, SERVICES,. . ] CA0000252405 <br /> ,rter 2 Gampany Name:, U.S.EPA ID Number <br /> veslgnatadFacility flame and SiteAddress " Ill EPA Ip Number <br /> . � y <br /> ? TFI $ "� ECOVERY SERI CADOW251406 <br /> 160EAST'RICO .RL V�� <br /> LOS ANGE,LES,. CA 90025 <br /> Facility's Phone: X499--71 <br /> 9a. gb U Sr,DOT Description(including Proper Snipping Name,Hazard Class,ID Number, 10:Cohtainers 11.Total 12.Unit 13.yyaste Codes <br /> HM andPsckngGroup(ifany)), No, Type Quantity" Wt.Nol. <br /> 'WOWACRAll, A-RbOUS WAt TE L IQUX WATERWRNE 33 <br /> o CLEANING $qL VT1QN) (CALIFORNIA R GUL.ATEC'r_ O <br /> fill <br /> LLA A <br /> W <br /> ., . <br /> 31 <br /> W60: <br /> t, <br /> ATEROORNE ..t .,:r <br /> y <br /> ..', <br /> 14.Stieclal Handling Instructions and Additional`information <br /> �. <br /> §= ACTIVE .CL T�4TN� .. ENE GEv C IRSpOR' ICT <br /> lilllI 1111lI11� Jill 1111111111111'. <br /> TAS R - <br /> 15: GENERATOR'SIOFFEROR'SCERTIFICATION:'thereby deelarethat the contents oflhis consignment are fully and accu[ately described,above by the propecshipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper contlitiottfor tiansportaccofding to:epplicable international and national goyemmental regulations.if export shipment and I am the Primary <br /> Exportet,I certify that the contents ofthis consignment conform to the terms of the attached EPAAcknowledgment ofConsent, 4 <br /> tcertity that the waste minimization statement identified in 40 CFR 262.27(a)(if I;am "large quantity generator)of(b)('dl a' a smal( is true. <br /> GeneratorslOfferors PnniedlTyped Name Signature Month Day Year <br /> t ' ' I <br /> a 16:Intemationai ShipmaMs " r <br /> E.. import to U.S. ❑Export from U.S..: Port of entry/exit <br /> Transporter signature(for exports only): Date leaving J S.: <br /> W 17.Transpoiter•Acitnowletlgm9nt of Receipt of Matenais <br /> Transporterl Printedfrypa ame S�pnature Month Day Year <br /> �/ <br /> z Transporter 2 PdnteNT`yped Name „' "',. Signature A/ Month Day : Year ' <br /> 18:Discrepancy;! ; <br /> 18a.Discrepancy indication Space <br /> Quantity ❑Type,` Residue :- - Pattiai Rejection ❑FulRejection <br /> Manife"st Reference Number: '� ' <br /> 18b:Altemaie Facility(or Generator) <br /> VV a U.S.EPA ID Number. <br /> uQ. �acilitys Qhone:. ` <br /> w 18c.Signature oiAlternate Facility(or,peneraior) s t Month Day Year' <br /> N 16.HazandousWaste,Report Monagement•Mettiod Codes(he,,.codes for hazardous waste treatment,tlisposal,and recycling systems) <br /> 1 <br /> 12; 3. 4' <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the mantfest except as noted in Item 18a t <br /> Printed/T a ame Signature Y <br /> r <br /> Month Year <br /> EPA Form 8700-22( ev.3-05) Previous edit ons are obsolete: ; `. . °` DESIGNATED'.FACILITY TO GENERATOR <br />