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F <br /> Please pant or type. Form Approved.OMB No.2050-0039 <br /> 0,AZARDOUS 1.Generator ID Number f 2.Page 1 of 3.Em� Ky Response Phone 14.Manifest Tracking Number <br /> K tttt •y <br /> ASTEMANIFEST CF(LOW346875 a. 1-800-499--7145 ®.�„ JJK <br /> 5.Generators Name and Mailing Address „`; Generatos Site Address(if different than mailing address) <br /> t 1650SA 1 STANF.DBRQ-ARDDESA GOLDEN GTE <br /> TRACY, CA s <br /> Generators Phone: <br /> 6.Transporter l Company Name U.S.EPA ID Number <br /> PACIFIC RESOURCE RECOVOY SERVICES CA0008252405 <br /> T.Transporter 2 Company Name U.S.EPA ID Number •- <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> PACIFIC RESOURCE RECOVERY SERVICES' CAD008252405 <br /> 3150 EAST PICC BLVD <br /> LOS ANGELES, CA 90023 <br /> FacilitysPhone: 800 499 .7145 <br /> ga', 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> _ No. Type Quantity wt./Vol, <br /> X .1UN1263,. WASTE PAINT RELATED MATERIAL, 3, D001 003 005 <br /> o PGI7G s; RQ <br /> DM G 21A <br /> r <br /> 14.Special Handling Instructions and Additional Information <br /> 9b1) AP# 6326 <br /> GLOVES, `GOQGLES &; PROTECTIVE CLOTHING 24HR EMERGENCY CO TACT< KIR WALD RF <br /> ERGN OR 12B illlll{Illllltlllllllllllll�lil�illlllllll l <br /> TRANSPORTER "1 PHONE �# 1-�888�-2 3'-1348 <br /> 15,,GENERATOR'S/OFFEROR'S CERTIFICATION:t hereby declare that the contents of this consignment are fully and accurate2 - <br /> GTtor's/0 <br /> ad above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper;condition for transport according to applicable intemationalandgovernmental regulations.If expork 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 g0antity generator)or(b)(if l am aantjtygenerator)is true. <br /> rs Printed/Typed Name Sign ture Mont a Ye <br /> , Y <br /> uIA.Inlernational Shipmelds <br /> El Import to .S. ❑Export(fto4 U.S. rl of entry/exit; <br /> Z Transporter signature(for exports only): Date leaving U.S::. <br /> CC W 17.TransporterAclmowledgmenfof Receipt of Materials <br /> Transpw ewhPrinted/Typed Name nature <br /> A <br /> D Y ar. <br /> a <br /> 5E Transporter 2 Printed/Typed Name tufe ' <br /> Month Day Year' <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity. F]Type Residue ❑Partial Rejection <br /> F71 Full Rejection <br /> r. <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Lai. Facility's Phone;, <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> N 1g.Hazardous Waste Report Management Methotl Codos(i.e.,codes forhazallous waste treatment,disposal,and recycling systems) <br /> LU 1. 2.• 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pri ped Name Signature Month Day Year <br /> J pik,..;ebi <br /> EPA Form 8700=22(Rev.12-17) Previous editions are obsolete: DESIGNATED FACILIT TO GENERATOR <br />