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QTSC. W2.0-1609 Please nrint or tvne. (Form designed for use on elite 112-nit61tvmekvriter.l Form ADoroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) 'Previous editions are obsolete. 12177.1818 DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of�RC . Emergency Response Phone 4. Manifest Tracking Number 14380358 JJ K WASTE MANIFEST 510.749.1390 5. Generators Name and Mailing Address Generators Site Address (d different than mailing address) Att MERILYN BEWNDER BNSF RAILWAY COMPANY BNSF RAILMAY COMPANY 740 E.CARNEGIE DR STOCKTON SUBDIVISION MP1119.5 TRACK 139 . SAN BERNANDINO CA 92408 STOCKTON CA 95206 Generators Phone: 6. Transporter 1 Company erne U.S. EPA ID Number NRC ENVIRONMENTAL SERVICES INC. IC A R 0. 0. 0 0. 3 0 1 1 4 7. Transporter 2 Company Name C U Number �tly � Sl�. �,-7�"% 8. Designated Facility Name and Site Address U.S. EPA ID Number Filter Recycling Services 480 W. Monte Ave. Rialto CA 92310 Faclity's Phone: Can ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (it any)) No. Type Quantity WtNd. ENVIRONMENTALHAZARDOUS SUBSTANCES, SOLID, obN3077, X N.O.S., (DEBRIS, SODIUM METHYLDITHIOCARBAMATE), 9, III -3H z LU 2. ca 3. 4. 14. Special Handling instructions and Additional Information WEAR PROPER PERSONAL PROTECTIVE EQUIPMENT; JOB/PO#. "77471 NRC ENVIRObaWNTAL SERVICES-. 1605 PERRY DOIN*P, ALAMEDA, CA 041S01 �'w,�, 951) PROFILE# 15090106, 2x55G 15. GENERATOR'SWFEROR'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 rational governmental regulations. If export shipment and i am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAr kr owledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(4) (if 1 am a large quantity generator) or (b) (di am a m uantity generator) is true. oe GenerstorsJOBerors Printed/Typed Name � L /� t �� Signature Mgajtt D® Year I j// `� /W[ !/ -j 1- 16. International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit F= Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Q- /j /+ Ac Eli ' /4 V V e Transporter 2 Printed/T ed N me Signature �. Marth Daty1 Year 41" 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Ful Rejection Manifest Reference Number. 18b. A@emate Facility (or Generator) U.S. EPA ID Number 6.p Ll Facility's Phone: w 18c. Signature of Alternate Faulty (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i e., codes for hazardous waste treatment, disposal, and recycling systems) p 1• q1 r 2. 13, 4. 20. Designated FaaTity Owner a Operator Certifigtiar of receipt of hazardous matedals covered by the ma ' t as tem I& PMtadfTyped Nara` Sig ` i t Year 0 A I n EPA Form 8700-22 (Rev. 3-05) 'Previous editions are obsolete. 12177.1818 DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)