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Please print or type. ?' Form Approved.OMB No.2050 0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 12.Page 1 of 3.Emer�iky Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST CAL000346875 L 11Ytt800- 499-71:45' ; 021748085 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ADESA CALIFsDBA ADESA: GOLDEN GTE <br /> - <br /> 18501, STANFORa RD <br /> TRACY . SCA 9W.77 <br /> Generator's Phene <br /> 6.Transporter)CompanyVame U.S.EPA ID Number <br /> ICAC+IF:I `,;Rt SflURGI* R O,1 ER f SERVICER CAD�tn8 5240 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> t,PACIF'-M;RIESOLlRCEL RECOVERY SERVICES CAD0082524105`. <br /> --31'50EAST�;ALCO'BLVD. ;,; <br /> LOS AN6ELES' CA 90023 <br /> FacilitysPhone:;.t ';;y+.t:$0tI19 i-499;=7145; <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol.. <br /> � �}�.fiL,'� <br /> "} <br /> .SW5`� <br /> TT- <br /> w <br /> �, 'X 2Ut 1c^f�3� :WASTfi PAINT: RELATED;MATERIAL: 3 <br /> DM, 6 (V 2x14 '} <br /> NOW RCWA IHAiARDOUS WASTE;,-L LOU VD <br /> .t WATERBORNE CLEANING.SOLUTIOU <br /> ., �DM, G <br /> 4. <br /> 14.Special Handling Instructions and Additional information gl 4F :56t} R, <br /> 6tE®VES' t�ESr s' 1P'ROTECTIVE C CITT, I IG< 24HR EMLRCbENCY C4>1NF JTi 'l�I`RK= W <br /> >aE*8 9b2) 128 9ts3k)r�rNONE all <br /> TRANSROt�TER b r.fPWONC,. ;,.1-88$ .2I'3r1'34& <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately escrib 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 intemational and anon 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 EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262:27(a)(if I am a large quantity en ator)or(b)(ifI auxwl quantity'generator)is true. <br /> e rators/Offe es Pdnted/Typed Name i ature Mo D Y ar <br /> 8. ntematio M IShipme <br /> F-1 Impo to U.S. ❑Export from U.S. ort of entry/exit: , <br /> Transporter signature(for exports only): Date leaving Ulf. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> 12 Transporter 1 Printe p me Signature Mo Y r <br /> � Al <br /> 0 <br /> Cn <br /> m Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 18.Discrepancy '% <br /> 18a,Discrepancy Indication Space ❑ Quantity + <br /> ❑Type El ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> ua Facility's Phone: <br /> Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z , <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 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 /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO'EPA's e•MANIFEST SYSTEM <br />