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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back O e 6. <br />Please pr' . Form designed for use on elite (12-pikh)rifer. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Wanifest Document No <br />WASTE MANIFEST ,� d� c7 t' If 11Y150 q r% 014'T <br />3. Generators Name and Mailing Address " 'A. Stote Mani <br />BNSF Railtarav Cc <br />740 E Carnegie Dirve <br />S. State Gene <br />LO San Bernard nc, CA 9240th <br />LO 4. Generator's P one 9Q9 ) 386- 4083 <br />N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Tran: <br />LO <br />aD <br />� <br />Filter Recvclina Services, Inc. '' D 9 8 4 4 4 4 8 1 d. Transports <br />CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Trans <br />�a <br />V <br />Q <br />�Z <br />O <br />a <br />V <br />Z' <br />3 G <br />c�i E <br />o N <br />w E <br />v R <br />v A <br />o T <br />a0o O <br />i R <br />Lu <br />Z <br />LU <br />U <br />W <br />N <br />Z <br />O <br />d <br />N <br />W <br />J <br />Q <br />Z <br />O <br />Q <br />Z <br />W <br />t - <br />V <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />Filter Recvcling Services, Inc. <br />180 W. Monte Avenue <br />Rialto, CA. 92316 9 8 2 4 4 4 4 8 <br />i l . US DOT Description (including Proper Shipping12. <br />/ Name, Hazard Class, and ID Number) No. <br />a. 1 �1+ 1 ®2 Fh✓O a d cn V di <br />b. <br />r <br />4 , � <br />11=111MN 11 22M 111M <br />Department of Toxic Substances Control <br />Sacramento, California <br />Page 1 Information in the shaded areas <br />is not required by Federal law. <br />of 1 <br />de Facility's ID <br />iners 13. Total 14. Unit <br />Type Quantity Wt/vol 1,:1. <br />2 «I; W► r w <br />15. Special Handling Instructions and Additional Information <br />24 HOUR EMERGENCY SERVTCE <br />MARK A. FREEMAN 909-322-0724 <br />WEA€? APPROPRIATE PROTECTIVE EQUIPMENf , <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and a 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 />C`i� <br />0 <br />E <br />available to me and that I can afford. <br />} <br />I <br />iRtl[otiaft/jfe]imad anent for BNSF Railwav <br />Signature <br />Month Day Year <br />Z <br />z <br />Mark P. Freemen <br />siac <br />/���ly <br />/ I <br />�hn')L, / d1.d <br />tis" <br />T17. <br />Trans orMaterials <br />1 Acknowled ement of Receipt oMaterials <br />w <br />p <br />Printed/T ed Name <br />Signature <br />Month Day Year - <br />LU <br />R <br />Y <br />W <br />P <br />B <br />18. Trans orter 2 Acknowledgement of Receipt of Materials <br />Q <br />RPrinted/T <br />T <br />YP ed Name <br />Si nature <br />9 <br />Month Da Year <br />Y <br />w <br />E <br />V) <br />R <br />19 DisYqe m <br />U <br />z <br />A <br />siac <br />/���ly <br />C <br />I <br />L <br />20. Facili n <br />1 <br />Printed <br />T <br />Y <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />E <br />of <br />SignatureM�, <br />onth Day Year <br />DO Ndf WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />