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�ript or type.(Form designed for use on elite(12- Itch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2 Page 1 of 3-Emergency Response Phone 4.Manifest Trackln Number WASTE MANIFEST GAD 0 2 9 6 0 3 7 0 3 -1 (190 3)xt24^9 300 31 JJK 5.Gen t f N d ai Qd sTOR Ny Generator's Site Address(if different than mailing address) 1620 E MINER AVe f Generator's Phone: 209 4644"1 6.Trans cher 100` Name U.S.EPA ID Number �dYORI,.10 31Ln ENVel RONMENTAL SERVriCrs' C A X10 2;)'2 7 7 0 3 E3 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facili�tyy Namrc�e aqj Site Address NAMR'K�J41i){•F't:E Ri-GO VERY U.S.EPA ID Number 3150 i. P100 BLVD, LOS ANGELES ES CA 90(X23 Facility's Phone: gBW4 714 C A ii G1 O 2 7 2 a;.f)J 0a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10;Containers 11.Total 12.Unit HM and Packing Group(If any)) 13.Waste Codes No. Type _ Quantity Wt Nol O .i 1.43N3.:2C3.WASTE PAINT'RELATED MATERIAL. 3, 1 i3 0,E 3 43 c p Fh U Z 2. W 0 3 r 4.. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEM7RP:c - n0 z • 3ca c I. TET��ttPtAL;P,I Its r NAt RG#98x:128 PROFILE#1981 r47fA128-010-320PAIN'FieOMMODITYPA(,'K *P%)-00090076*AIoY-`F alxlRIttT PIPE EQUIPMENT -a 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping 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 governmental regulations,If export shipment and l am the Primary Exporter,I cedify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. - I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. - GeneratorslOffrorsPrinted/Typed Name Signature . -a y.. - MantO Day Year _ 16.International Shipments ❑ _ fs- Import to U.S - El Export from U.S: Port of entrylexlt Transporter sinature(for exports only): Data leaving U.S.: - w 17.Transporter Acknowledgment of Receiptof Materials bi Transporter 1-Priited/Typed Name = Signature Month Day - Year CL " Za Transporter 2 Prinledfryped Name Signature Month Day Year K _ 18.Discrepancy Inc.Discrepancy Indication Space ❑ Quantity ❑Typa ❑Residue ❑Partial Rejection f ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: Qw 18c.Signature of Alternate Facility(or Generator) Month Day Year z N 19..Hazardous Waste Rep but Management Method Codes,(i.e.,erodes for hazardous waste treatment,.disposal,and recycling systems) D 1 2. -- —r— . 4, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materialscoJered by the manifest except as noted In Item l Be PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. - GENERATOR'S INITIAL COPY