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-Flease'print or ype. ,;` :; Form Approved.©MB No.205011039 <br /> Page 1 of 3.Ern 4 Mapifest Tracking Number <br /> WASTE MANIFEST <br /> I. enerator ID Number CAL000345878: Pa ],-0.20377n&9•9 •J J K <br /> U RM HAZARDOU 9 � �,.�8�-^�49�-w7�,45 <br /> 6.Generator`s Name and Mailing Address Generators Site.Address(if different than mailing address) <br /> ADESA 'CALIF.DBA ,ADESA GOLDEN GTE <br /> 18501 STANFORD RD <br /> TRACY, CA 95417 . <br /> Generator's Phone: Jae 2092241494 <br /> s:TPACIFIC RESQURCE RECOVERY, aERVI u,S.EPAIDNumber <br /> P P Y <br /> CES CAD'. 8252405 <br /> 7.Transporter 2 Company Name U.S;EPA ID Number " <br /> 81 Oesignatedfaoility Name and Site Address " U.S:EPA ID Numtier <br /> PACIFIC RESOURCE RECOVERY 'SERVICES CA[10o82:2405 <br /> 3150 EAST PICO BLVD, <br /> TOS ANGELES, CA 90023 <br /> FacilitysPhone: (800) 499--7145; <br /> ga. 9b.U.S:DOT Description(including• roper Shipping Name,Hazard Class,ID Number, 10:Containers" 13.Waste Codes <br /> and Packin Group(if 11.Total 12 Unit <br /> HM 9. P( Y)) No. Type Quantity Wt.Nol. <br /> �yy _ <br /> ke <br /> 21"x! <br /> W ?t 2 6, WASTE PAINT RELATED MATERIAL, 3 D001'' 003 006 <br /> c� PGll, RQ, (0001) G 214 <br /> 3NON' RCR . -HAZARDOUS WASTE LIQUID (WATERBORNE 133 <br /> CLEA ING SOLUTION) (CALIFORNIA REGULATED' DN A <br /> 14.Special Handling Instructions and Additional Information <br /> b5. 8"',�9b2) 5328 9b3) AP 6339 -' <br /> RA P ». Y Y Cta TAM KIRK WALDORF <br /> T ISS CRT R_1 PHONE 1 ,bas . lillllllllIl1111illi Illll litllltlllll, <br /> GLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR E tRGEN <br /> 9b2 128 9b3 NONE <br /> 15. GENERATOR`S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,and are classified,packaged,, <br /> marked bird labeled/placarded,and are in all respects in proper condition for transport according to applicable internationaland national governmental regulations.If.export shipment and t am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcRnowledgniaht of Consent. <br /> Ccertity)hat the waste minimisation statement identifed in 40 CFR 262.27(x)(ift am a large quantity generator)or b)('dt'm a, quanti gener tor)is true. <br /> Gen t Iferoes Printe Eryped Name Si Sture z Mong} Day Y2at <br /> (/� d'J <br /> 16.International Shipments <br /> t= 1:1 Import to U.S. Export from U Port of entry/exit. <br /> ? Transporter.signature(for exports only): Data leaving il. <br /> Lu17.,TransporterAdcnowledgmentofRecetptgfMaterials <br /> CTransporter.9 PrintedRyped NameSignatureMonth aye Year <br /> Transporter 2 Pnhted(ryped Name Signature <br /> Month Day Year <br /> H <br /> 18.Discrepancy <br /> r, <br /> 18a,Discrepancy Indication Space, Quantity ❑Type yp ResiduePartial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility,(or Generator) a U.S.EPA ID Number' <br /> tai Facility's Phone: <br /> 0 1ec.Si nal re of Aitemate Facility or Genera"for <br /> 9 ty( ) [Month Pay Year <br /> 19.1Hazardous Waste Report Management Method Codes(i.e.,codes forhazardous.waste treatmenl;disposal,and recycling systems)' <br /> p 1 2, <br /> 1 <br /> 20.Designated Facility Owner or Operator:C i icaron,Rtreceipt of hazardous materials covered by he manifest except as noted Item 1861 <br /> Printed pe Name Signature Month " Day Year <br /> )19 <br /> �@ <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATO <br />