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02-15-17;07:56 ; 812094683433 # 3/ 3 <br /> ••.� ••.•••w r,lrtrr Tara.R aouv,A aV,11 art erten tto,,..eg 14NL1 alai:) Call!:e11111mc111 .' „. .. .. <br /> When completed,please Fax or Email Profile Mptanee <br /> (909)873-4142! :rofilin (a),Cilterrec clip .co <br /> Filter Recycling Services, Inc. nate: <br /> P.O.Box "9- Colton, California 92324 Authorized By: ENlliRONNIE <br /> ffAL <br /> A. Generator lgfortneila n N celrnd C Check I j'annlicarblc !l. MILS atf+ ENT <br /> Generator Name: FA-111-0Y ,2. Mailing/Manifest Address: Name. <br /> Site Address: 0.1 6:. ,4.MO�0Q '5r O;K P CRR&"-6 xd- k2 T C. Broker irtPOt—Inartitrra. <br /> City,State,Zip 95 zv b T-%08 Nance: <br /> U.S.E.P.A. Ili M C p D g S l y 5q j Yt� S.I.C.Code: Address: <br /> Technical Contact: tt 4,r -rt Z Email: Contact: <br /> Phone Number. 09. jz7r G9 qq Fax Number: Phone: <br /> Name of Waste: 0 f Fax: <br /> Process Generating; Email: <br /> the Waste: ex C9L(-• ,5 py_e-t- e A^j U)00 <br /> All !QH ANY MSDS and ANA UTICAL THAI HAS SEEN PERFORMED <br /> D.Characrerlsdcs <br /> Co(or Od-r FLvsfcal S7ete„fit 70'” Lavers E Meek None ❑T CLC:m d $'t"t.4'in 1:1 TCL <br /> m <br /> VARIES ❑ Nontd <br /> ® Li ui9 ❑ Multi-layerc+l Arsenic Selenium Nickel <br /> HT /L8 Mild ❑ Send-Solid ❑ Hi-layered Barium Silver Thallium <br /> ❑ St"'ng Solid Single Layered Bement Ashvstos Vanadium <br /> ❑ 140-200011 I}enc ArL@ LW&!s Cadmium Beryllium Zinc <br /> ❑ <700 F 2000 F I.bs/(:ai " No Chromium Cobalt _ C:yxnides <br /> ❑ 70-1000 F ❑ No Flash Lbs/Ft ❑ Yes Lead Copper Pesticides <br /> © 101-139°F Exact API Gravity % Mercury Mntybdcnum <br /> E,fl llarrge F.PhysicalfCheanreal C"M asitlan G. Shin & Irrfrrrnfation <br /> 7, G+C go -,70 % Proper Shipping Name: <br /> /VdlN pe.Gmt} <br /> 2.1-.4 t SES ' ®�° <br /> 4.1-10 - % Nazord Class: UNINA A.- PG: <br /> ® 10.1-12.4 % State Code: Flp'A Vode: <br /> % RCRA HnArdous ®Yes ®No CERCLA ©Yes ONo <br /> ❑ Exact % aste is exempt from RCRA regulations,LIST Remedlation,per <br /> 40 CFR 261.4(b)(10) <br /> TOTAL (shomid 100%) % []This waste Is excluded from RCRA relations,Commercial Chemical <br /> Product, r 40 CFR 261.2(!i2(ii <br /> Volume: r X-5S <br /> 09 due-Time <br /> ❑ Bulk Liquids © Balk Salfdv Drwrrr s Drums Boxes/Sacks ❑ Monthly <br /> Aft%Lod g Shlvtrrent Truck Gallons Yards u Annually <br /> ff. Special Haarr Ung Wear pWper PFE when handling Lab Pack <br /> In rmrrtlorr: ❑ Commodity Fuck❑ Consolidated <br /> Generator or signatory below,of this waste,certifies that the information above is true and accurate and that the determination of <br /> this waste stream was derived by state certified analysis and/or generator knowledge,if the physical or chemical composition of the <br /> waste changes,the generator will notify Filter Recycling Services Inc.prior to shipment.The generator and signatory below are <br /> solei res onsible for all costs associatedwith the rn er disposal of an material delivered to Filter Recycling Service Inc. <br /> Si,�naixrre: Fruited Title: Dale: / <br /> Natne: <br /> Revised 3129113 <br />