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Pase print or type:, Form Approved.OMB No.2050-0039 <br /> UNDO M HA7,ARDOtlS GeneratorlD Number"1. 1s 2.Page 1 of 3.Emgrggpcy Response Phone 4.Manifest Tracking Number <br /> „VIS .MANIFEST C.�Lt346875 1 1--8499-7145 J:JK <br /> 5.Gr er tot's ame and Mailing Address ' Generator s SdeAddress(if different than mailin address <br /> AD SA CALIF. 'A E <br /> 18501 STANFORD D' <br /> TRACY, 'CA 915W-l"," r. <br /> Generator's Phone: <br /> �)94-1494 <br /> 6,Transporter 1 Companyt ' U.S.EPA ID Number <br /> PACIE > RESOURCE RECOVERY SERVICES. CAD 8252A05 <br /> 7,Transporter 2 Company Name U,S.EPA'iDNumbec <br /> to, <br /> 8:Designated Facility Name andSite Address U S.EPA IDNumber <br /> PACIFIC RESOURCE RECOVERY SERV;CES CAD008252405 <br /> 3150 EASTPLCO BLVD. <br /> LOS ANGELES CA190023 <br /> FacilitysPhone; $ 499^.71$5 <br /> 9a. 9b,,U.S.DOT Description(including Proper Shipping Name,.Hazard Class,ID Number, 10.Containers 11:Total 12 Unit 13:Waste Codes <br /> HM ,and Packing Group(if any)) No. Type Quantity, Wt.Nol. <br /> e <br /> 16 <br /> w > <br /> t, PGII, RQWASD�IAIN'i RELATED hiA' feRTALi 30 001 43 > 6 <br /> DM G 214 <br /> MON RCRA 'HAZARDOUS WASTE LIQUID (WATERBORNE 133 <br /> CLEANING SOLUTION) (CALIFORNIA REGULATE[ DN 0-1 <br /> G <br /> 7-5 <br /> 4 ' . <br /> i <br /> 14.Special Handling'Instructions and Additional Information " <br /> 6326 9b3) AP # 6339 <br /> GLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT: 1�IRK WALDO�F <br /> ERCP : b 128 9b3 NONE IIIb II11I I IJ II�� . II Illi Il1l1i�l1 <br /> TRANSPORT R 1'—PHON # 1-888—'213-1348 <br /> 15. GENERATOR'SIOFFERQR'S CERTIFICATION:'t hereby declare that the contents of this consignment are fully and accurately described 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,intematiooaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknpwledgment of Consent. <br /> [certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity,generator)or(b)(ifta mall quantity generator)Is true; <br /> G n at`s Offeroes`Pnnted/Typed Na Si are Month Day Year <br /> 16.International Shipments <br /> ❑import to U.S. El Ex ort from U.S. Port <br /> F- P p try/exit: <br /> z Transporter signature(for exports only): a e leaving U.S.: <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> Uj <br /> ti Transport rinted7Typed Name / Si nature. Mon. Day Year <br /> Transporter 2 Printed/Typed Name Sign Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication SpaceY <br /> 0 Quantity ED Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S:EPA ID Number <br /> W Facility's Phone:,, <br /> W 186,Signature of Altemate Facility(or Generator) Month Day ,Year <br /> a n <br /> 19.Hazardous Waste Report Management Method Codes(r.e:,codes-for haiardous waste treatment,disposal and recycling systems)LLJ <br /> - � <br /> 1. 2. 3. 4. <br /> 20,Designated Facility Owner,or Operator:Certification of receipt of hazardous materials covered by the`manifestexcept as nded' Item 18a <br /> Printed/Ty a Nae Signature /. Month. `Day Year <br /> Iq <br /> EPA Form' 70 Previous editions areobsolete: _ DESIGNATED FACILITY TO.GENERATOR <br />