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Please print or type.(Form designed for use on elite(12-pi)ch) pewriter.) Form Approved.OMB No.2050-0039 UNIFORM. AZJIRDOUS -1.Generator ID Number 2,Page 10 3.Emy Response Phone 4.Manifest Tracking Number 1NA " MANIFEST t 3S �45�—X145 J:JK 5. ener`ators Name and Mailing Address Generators Site Address(if different than mailing address) Pe SA x,'4/11: /2,6/7 Edi dJe�in! �/�� . Ar Generators Phone: d3 a 6.Transporter 1 Company N e U.S.EPA ID Number PACIFIC RESOURCE RECOVERY SERVICES CAD0108252406 7.Transporter 2 Company NameU.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number PACIFIC RESOURCE RECOVERY SERVICES CoA O262405 3150 EAST PICO BLVD. LOS ANGELES, CA 90023 Facility's Phone: 499-7145 ga.. 9b.U.S.DOT 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.Nol. a Z a 2. " b3o WA51*t PAINI RELAILDWIMIRIAL, J. ; LU PGIIsa RQ, (D 1) OIC97, G 3LEANING SOLUTION) (CALIFORNIA� REGULATED ONLY) i\ G 4. 14.Special Handling Instructions and Additional Information 9b2) AP# 6320 9b3) AP 6339 GLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: KIRK WALDORF E G s 4 02) 128 b3) NONE TRANSPORTER I 1-888-213-134 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descri d bove 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 natio I vemmental 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 EPAAcknowledgment of Consent. 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 s uantity ge erator)is true. Ge rators eroes Printedlryped Name Sign re" Month Day Year 2 ilk J 16.In emational Shlpmdhts ❑Importto U.S. ❑Export from U. ort of ntry/exit•. 2 Transporter signature(for exports only): Dae eaying U.S.: W 17,TransporterAcknowiedgment of Receipt of Materials Tra 1 Printed/Typed Name SI ature Month Day Y ar I I co Q Transporter 2 Pdntedrryped Name ign a Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ElEl T El Residue Quantity Type ❑Partial Rejection 0 Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) { U,S.EPA ID Number V LL Facilitys Phone: U 18c.Signature of Alternate Facility(or Generator) Month Day Year a 19.Hazardous Waste Report Management Method`Codes(i.e:,code"'forhazerdous waste treeatment,disposal;and,recyding ystems)' G 4, Nu 1)(Q 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a PrintAdp d Name Signature "� Month Day Year i - EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR