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Please print or type. ' t r= _ h. ; "'. '" Form Approved,OMB No.2050-0039 UNI M HAZARDOUS 1.Generator ID Number F"' 2. age 1 of 3.Em �y Respon9 Phone 4,Manifest Tracking Number YZ A§TE MANIFEST CAL000346876 1 1-~8�^499' 71.45 JJK IrGenerators Name and Mailing Address Generator's Site Address(if different than mailing address) x ADESA CALIF.D8'A ADESA GOLDEN GTE 18501 STANFORD-' RD TRACY, CA 9t7 Generators Phone: 6.Transporter 1 Company' ame U.S.EPA ID Number PACIFIC RESOURCE RECOVERY SERVICES CAD008252405 7.7ransporter2 Company Name U.S.EPA ID Number 8:Designate EacilitY-Wm and`SlteAddress si U.S.`EPAID'Number PACIFIC RESOURCE RECOVERY SERVICES CA0008252406 $160 NST PICO BLVD. SOS,-A ELES, CA 00023 Facility's Phone: <. 800 459^7 .45 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM;, angd�PackmggpGroup(ifa�ny))) No. TYPe. Quantity Wt.Nol. q. G- z X zUN1263, WASTE PAINT RELATED MATERIAL, 3, D001 003 X05 ® PGIID 'NQD (0001) DM G 214 �l3 :��5 i 0001 8 5 . d �AD . 'NON 'RCRA 'HAZARDOUS WASTE 'LIQUID (WATERBORNE 133 CLEANING SOLUTION) (CALIFORNIA REGULATEDDN G 14.Special Handling Instructions and Additional Information P '21B�' 9b2 , AP#k 6328 9� �4 9b4) AP#� 6339 GLOVES:a, GOGGLES & PROTECTIVE GL®THING 24HR EMERGENCY CO .TACT KIR WALDORF 9b2 A28 �-��9b4) NONE Il 111 111111 l �lll llll' !I ILII l 1111111 f ., TR NSPORTER1 PHONE 0 1-888-21:3 1348 t 15. 'GENERATOR'SlOFFEROR'S CERTIFICATION:1 hereby declare that the'contents of this consignment are fully and accurately described'abo0e by�theropershipping name,and are classified,'packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmentulations.If export shipment and Iam the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. I certity that36e waste minimization statement identified irr40 CFR 282.27(a)(if I am alarge quantity generato o (ifi am a small qu geness true. vera erorsPrinted ped Name Si na r Mq� a/� Year 302z� 16.International Shipments H Import to U.S. Export from U.S. Port of en exit: . Z Transporter signature(for exports only):. Date leaving U.S.: 17.TransporterAdmowledgment of Receipt of Materials LLITransporter 1 Pdnted/Typ d me Signature Monthggay Y a z Transporter 2 Primedfryped Name Signature Month - Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type j yp ❑Residue ❑Partial Rejection El Full Re ection Manifest Reference Number: .. . AL 18b.Alternate Facility(or Generator) U.S.EPA ID Number U- Facility's Phone: W' 18c.Signature of Alternate Facility(or Generator) Month Day Year - N' 19.Hazardous.Waste Report Management`Method Codes(i.e..codes for hazardous wasle'treatment,disposal,and recycling systems). G 1. 2. T- 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a £ , PMinteyd NameV Signatur Month Day Year EPA Form 8700-22 ev.12-17) Previous editions are obsolete: DESIGNATED FACILITY TO',GENE OR