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11
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<br />Filter Recycling Services, Inc.
<br />7. Tran
<br />sporter 2Campo y Name 8. US EPA ID Number E State Transporter's ID [Reserved.[
<br />F( �sr � F. Transparter'sPhone gn t7 WV .
<br />9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facili s ID /
<br />Filter Recycling Services, Inc. i
<br />180 W. Monte Avenue H- Facility's Phone
<br />Rialto, CA 92316 9 3 2 4 4 4 4 8 1 (909) 421.-2612
<br />12. Containers 13. Total 14. Unit
<br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. Type Quantity Wt/vol I. Waste Number
<br />a' ;4t 6 {ra 2 ✓L d. a v,S was $'7'4' G / s.. y L? State
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<br />S'i8LlPanftjj�,gWstggr'd� ` rfILj' °nnqL"- —721-20 3 $
<br />WEAR APPROPRIATE PROTECTIVE EQtTI NT
<br />.�. T"�'" t� I /� ®�a d�'y vat �✓ .S"�..- �T..� r e°'- ;,"v r...- ,"'�'�• t� . t.-ti.� .
<br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed,
<br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically
<br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health
<br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br />cd
<br />available to me and that I can afford.
<br />OPrinted/Typed
<br />:alifo_r , , Environmental Protection Agency
<br />d B 2050-0039 (Expires 9-30.99)
<br />See Instructions on back of a 6.
<br />Department of Toxic Substances Control
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<br />�,,, c..71? ,�! r'? ?J� •-lr:..� -'.x�.
<br />Sacramento, California
<br />17,: FORM HAZARDOUS
<br />A
<br />1'. Generator's US EPS. ID No Manifest DocumenGNo. Page 1
<br />k' e• `' " t 4
<br />Information in the shaded areas
<br />is not required by Federal law.
<br />WASTE MANIFEST
<br />.') 1C.
<br />I 4% of 1
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<br />3. Generator's Name and Mailing Address
<br />BNSF Railwav Co
<br />Month Day Year
<br />A. State Manifest Document
<br />Number
<br />740 E Carnegie Dirve
<br />B. State Generator's ID
<br />18. Trans or e'r 2 AcknowledgemeilLof Receipt of Materials
<br />S4gap� B�r�lgrdino, CA 92408
<br />4 Generators Phone ( )
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<br />5. Transporter 1 Company Name
<br />6. US EPA ID Number
<br />0 00 0
<br />C, State Transporters ID [Reserved.[
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<br />Filter Recycling Services, Inc.
<br />7. Tran
<br />sporter 2Campo y Name 8. US EPA ID Number E State Transporter's ID [Reserved.[
<br />F( �sr � F. Transparter'sPhone gn t7 WV .
<br />9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facili s ID /
<br />Filter Recycling Services, Inc. i
<br />180 W. Monte Avenue H- Facility's Phone
<br />Rialto, CA 92316 9 3 2 4 4 4 4 8 1 (909) 421.-2612
<br />12. Containers 13. Total 14. Unit
<br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. Type Quantity Wt/vol I. Waste Number
<br />a' ;4t 6 {ra 2 ✓L d. a v,S was $'7'4' G / s.. y L? State
<br />3 Ij t .1 i l• ..r ar •ir " s r i
<br />a
<br />141
<br />G
<br />S'i8LlPanftjj�,gWstggr'd� ` rfILj' °nnqL"- —721-20 3 $
<br />WEAR APPROPRIATE PROTECTIVE EQtTI NT
<br />.�. T"�'" t� I /� ®�a d�'y vat �✓ .S"�..- �T..� r e°'- ;,"v r...- ,"'�'�• t� . t.-ti.� .
<br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed,
<br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically
<br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health
<br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br />cd
<br />available to me and that I can afford.
<br />OPrinted/Typed
<br />Name r? s /yam f , % ted' S,
<br />Signature
<br />Month Day Year
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<br />17. Transporter 1 Acknowledgement of Receipt of Materials
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<br />Printed/Typed Name
<br />Signature
<br />Month Day Year
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<br />18. Trans or e'r 2 AcknowledgemeilLof Receipt of Materials
<br />O R
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<br />ts Na Prince T pe
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<br />Signa ire �!
<br />Month _DaYYear�
<br />V19. Discrepancy In ication Space
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<br />20. Facility Owner or O rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. s:
<br />T Printed/Typed Nar!!!: Signature *^" Month Day Year
<br />Y `e ♦�� �. •,'rte^' /N.-7 1 e^> t
<br />DO NOT ITE BELOW THIS LINE.
<br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br />DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state,
<br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)
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