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F <br /> Please print or type.(Form designed for use on ellte(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS I,Generator ID Number 2.Pegs 1 d 3.EmergencyResponse Phone 4.Mantfest Traokin Number <br /> WASTE MANIFEST CAL0002 0 0 4 2 5882 J J K <br /> 5.Genereto(s Name and Melling Address Generator's Sue Address(B tllBarem than melting address) <br /> CIRCLE N STORESIMICHELLE WILSON CIRCLE K#2701205.16470 CAMBRIDGE <br /> 495 E RINCON,STE 150 LATHROP,CA 95330 <br /> CORONA.CA 92879 <br /> Genemloys Phone: 4116 <br /> 6.Transporter 1 Compsny ms 852 U.B.EPA ID Number <br /> ENVIRONMENTAL LOGISTICS INC <br /> i.Transporter 2 Company Name US.EPA ID Numbs <br /> B.Designated Fedfily,Name and Site Mamas US.EPA ID Number <br /> FILTER RECYCLING SERVICES.INCA n ASA 44a1 <br /> 180 W. MONTE AVE <br /> 'RIALTO,CA 92316 <br /> Facial s Phone: 800-698-4377 <br /> It, 91b.U.S.DOT Descrip5on(including Proper Shipping Nemo,Hazard Class,ID Number, 10.Canlaners11.Total 12.UNI 13.Wash Codes <br /> HM and Padang Group N any)) No. Type Dustily Wtivol. <br /> C 1' NON RCRA HAZARDOUS WASTE SOLID I DM I swo P 352 <br /> I 2NON RCRA HAZARDOUS WASTE LIOUID '� DM s-o G 134 <br /> 4. <br /> 14.Special Handing Insbucierts and Additional Information r <br /> 981)FUEL FILTERS#03102111 J$0—C' WEAR APPROPRIATE PPE WHEN HANDLING. INV#58815-N <br /> 9B2)WATER WIGASM03102110 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fdiy,and ecctntely described above by cine proper shipping name,aN are classified,packaged, j <br /> narked and labeled1docarded,and are In all respects In proper condition for Uwwon according to applicable tntemalional and national governmental togulatlmm.If export shipment and I=the Primary <br /> Exporter,I tangy that the contents of this consignment conform to the terms of he attached EPAAcknoWedgmenl of Consent. <br /> I certify that the waste minimization statement Identified in 4 CFR 26227(a)(if I am a large quantity generator)or(b)Off am a amaA uang nereter) <br /> Ganyarp M ear's Prin Name Saura1� Mo9m / y,_ year <br /> .a 16.InevrollonalSNpnads 1/D /U <br /> F hnpon to U.S. Expolifrom U.B. Port ofenUy/exR <br /> M Transporter signature(for exports orly): Dale leavkg U.S.; <br /> W 17.TramporterArhnoeledgmemd R dMakinds <br /> 7pnsporler 1 Pdnled/f 3I A1oph �I Year <br /> a L FGA <br /> N <br /> transporter typeariamia Iu2 Month OeY Yqk <br /> K <br /> to.Discrepancy <br /> 18a.Discrepancy nc9callon Space ❑ candyType ❑Residue ❑Paruw Rejection ejection <br /> j, g t ❑FrIIR <br /> 4k1)w'?rN recedues/ dr Ar's", Lusts 4- IU7-ler <br /> MCNfesl Reference Number. <br /> 18b.Alternate Facility(or General 0.5.EPA ID Number i <br /> U <br /> LL Facity's Phone: <br /> W 18&.Signature of Allende FacaBy(or Generator) Marin Day Year <br /> H19.Hazaroous Waste Report Management Method Codes(i.e.,�codes for hazardous waste treatment,0ieposal,and recycling systems) <br /> 20.Designated Faci4y Owmr or Optar:Certification of receipt of hazardous mele4als covered by the manliest except as noted In Item Its <br /> Pnnletl/Typetl NamSignature Month Day Year <br /> a L <br /> EPA Form 8700.22(Rev.3-0S) Pre 'ous editions are obsolete. DE NATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> I <br /> t <br />