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Tighe grin r type.r rm designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 AZARDDUS 1.Generator ID Number 2.Page 1 of 3.EmpWy Response Phone 4.Manifest Tracking Number ASTE IW,,IFEST� : sL E7 . —800-499-7146 JJ V, 5,Generators Name and Mailing Address _? '.� Generators Site Address(if different than mailing address) AOESA CALIE.DSA AD�SR'EDLDEN GTE 18501 STANF , RD TRACY, CA 9S V7 Phone: 6.Transporter 1 Company Name U.S.EPA ID Number PACIFIC RESOURCE RECOVERY SERVICES CAD 8252405 7.Transporter 2 Company Name U.S.EPA ID Number 8.Des! Facility Name-and,61teAddress PACIFIC RESOURCE RECOVERY SERVICES CAD 5252��5 3160 EAST PICO BLVD. LDS ANGELES, CA 90023 Facility's Phone: (8 00) 499-7145 ga, 9b.U.S.ROT Description(including Proper Shipping Name,Hazard Class,ID Number,. 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.NOI. 10N125 WASTE FAINT RELATED MATERIAL, S 117001 S C s 611 a RQ, (DWI) ON 6 214 z zNON .RCRA HAZARDOUS WASTE LIQUID ATERSDRNEUj 1ST CLEANING SOLUTION) (CALIFORNIA R 6UL TED ONLY OF 14.Special Handli g Instructions and Additional Information a= _ 0 F GLOVES, GOGGLES PROTECTIVE � � � ERs 1) 128 ) NDE TRANSPORTER', PHONE ,1—S - m k Y y Y Y proper shipping packaged, 15. GENERATOR S/OFFE OR'S CERTIFICATION: I hereby declare that the contents of this consignment are full and accurately described above b -the ro er shi in name,and are classified, acka marked and labeledipiaoarded,and are in all respects in proper condition for transport according to applicable international and natio7alovemmental regulations.Ifexport shipment and i am the Primary Exporter,I certify that the contents of,this consignment conform to the terms of the attached EPAAcknowledgment ofConsenti certify that the waste minimization statement identified in 40 CFR 262,27(x)(if I am a large quantity generator)or(b)(if I am a Intily generator)is true. Gener`ors/0fferor Printed/Typed NameS n re Month Day Ye„r V 10 A/ .Int ational Shipments F ❑import to U.S. ❑Export from U.S. P of entry/exit: Z Transporter signature(for exports only): ate leaving U.S.: W 17.TransporterAcknovriedgment of Receipt of Materials Transports rintedlTyped Name Signa�ure Month Y a ' QTransporter 2 PrintetllTyped Name Sig Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej El Full Rejection ❑Partial Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) .U.S.EPA ID Number J 14 Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z ; 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 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 Prints d/lyp Nae SignatureMonth Day Year EPA Form 8700-22(Rev.3-S Previous editions are obso ete. DESIGNATED FACILITY TO GENERATOR