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State of California—'Elivironmental Protection Agency <br />Form Appepv'A OMB No. 2050-0039 (Expires 9.30-99) See I]1t5$TUC$IOOS OR I3CC�C O� a 6. Department of Toxic Substances Control <br />' a <br />Plegsejsrint or type. Form designed for use on elite (12 -pitch) rifer. - Sacramento,, California <br />1 <br />UNIFORM HAZARDOUS <br />MANIFEST <br />1. Generator's US E` ID j d' 9 v Manifest Document No. 2. Page 1 <br />*� r <br />InFormation in the shaded areas <br />is not required by Federal law. <br />WASTE <br />t of j <br />3. Generator's Name and Mailing Address <br />2NS F° Railway CO <br />A StateManifest Document Number <br />740 E Carnegie Drive <br />B: State Generator's ID <br />LO <br />San Bernardino, CA. 92408 <br />' <br />to <br />4. Generator's Phone ( 909 ) 386--4083 <br />f 3 1 <br />" N <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. StdteTransporter's1Q[Reserved.] <br />00 <br />0 <br />Filter ;'Recycling Services, Inc. $ 4 $ i <br />D. Transporter s Phone f 9,191 6,7 <br />•; <br />tf <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E: State Transporters'ID [Reserved.] <br />+.. Q <br />; <br />FS Transporter's Phone <br />io V <br />si na Facili N me and Sije Address 10. US EPA ID Number <br />E9ii��recc�lna Services, Inc. <br />G. State Facility's ID <br />Ll � (4if 1- <br />Z <br />Z <br />180 W. Monte Avenue <br />H. Facility's Phone <br />�, O <br />U-_ <br />Rialto, CA 9233.6 C A D 9 8 2� 4 4 4 8 1 <br />i 9091 421-2�3 <br />Q <br />U <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />1. Wosfe Number <br />No. <br />Type <br />Z <br />a. <br />fd / <br />W7, ✓�P ,� <br />State <br />EPA/Other ,. <br />ostale <br />N <br />b• <br />°O <br />ao <br />�r <br />E <br />R04 <br />1 <br />EPA/Other <br />S T <br />`,FILTER RECYCLING SERVICES' RIALTO FACILITY <br />FPA <br />State <br />00 <br />0 <br />R <br />#CAD982444431 HAS THE A P%RC-PRIATF PERMIT(S)) <br />F R <br />J. <br />EPA/Other <br />AND <br />HIPPED. <br />slat <br />EPA, h, <br />W <br />U <br />W <br />V) <br />4Z 1mtta%Descr�phonsforMaterials tfsted'Above , # g <br />K. Handling Codes for'Was`tes <br />Listed Abwe <br />OCL <br />Qne or afore of the materials fisted in section f t Of tris ' <br />c. <br />d. <br />manifest may beareCycled as altelnatixe daily Bove CADC?. <br />Q <br />_. � . s � ° m hadwhich ries the Material in or dti',tbe land. <br />,. , <br />Z <br />O <br />'1 Sft"ang jVR@M53ynd�i85ipl�prmation Site: BN F Rc11 1 W3 V CO y <br />Q <br />MARK A. FREFFaMAAt 909-322-0724 <br />A Si✓�i>t%> iC;�'1 <br />Z <br />� r,°> 9 M1 �_T <br />PROTECTIVE EQUIPMENT Ba s W, - <br />�G'EAR�.A�+�P{+PjROPRIATE <br />:i i:+e YTOI CES 1r <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 are classified packed, <br />labeled, in respects in proper condition for tronspo by highway according to applicable international and national government regulafions.'" <br />Vmarked, <br />and and are all <br />®t <br />a <br />If 1 am a large quantity generator, I certify that 1 have a progiam in puce fo reduc' t e volumesand toxicity of was ¢enerated to the dggree 1 have determined ro 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 />N <br />and the environment; OR, if t 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 />Ci-' <br />O <br />available to me and that I can afford. <br />VPrinted/Typed <br />Name y <br />Signature .�' <br />onth, Day . , Year <br />Z? <br />W <br />6 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />LU <br />R <br />s.� <br />Printed/Typed Name <br />Signature. �`' <br />Month Day Year <br />-71 <br />r l <br />W <br />LL <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />0 <br />T <br />Printed/Typed Name <br />Signature '1... -a <br />Month Day Year <br />Lu <br />N <br />F <br />R <br />- <br />U <br />19. Discrepancy Indicotion Space <br />ZF <br />_ <br />p <br />f <br />20. Facility Owner a O orator Certification of receipt of hazardous materials covered b `this manifest except as noted in Item 19. <br />T, <br />Printed/Typed a <br />Signature <br />Month Day' <br />Y <br />^Year <br />DO NOT WRIT LOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 80 22A (1/99) (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 />EPA 87022A <br />