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Please mjpt or type,(Form designed for use on elite(12-pitch)typenenter.) Farm Approved.OMB No.2050-0039 <br /> 111411 HAZARDOUS 1.Generator ID Number 2.Page f of 3.Emergency Response Phone 4: an o<Thesdin Names <br /> WASTE MANIFEST 006628529 FLE <br /> 5.Geral Name andja8ilin ' " m cess(ddi6enenl than mailing Menisci <br /> 'IR'" inc. ,i-k.a. Mc Frei_ht DSF Reddaxay= <br /> 9J.3-344-52Q!5 10M, Fm Ave 3'%73 i'00mir R.1 <br /> Generator's Phone' c n• n� <br /> . ransponerI party Name "' -- '- U.V,PAID um' <br /> 7 TWder2 on ny .<...,I <br /> Gti�,Ratauz.t ;a� i.._o(.4 t,I 5 S+vC . C ��ji'OD 2175 i3 <br /> e.Designed Facility Name and Site Address U.S.EPA ID Number <br /> Filter P.eDvciiug ServiDes, Ina <br /> 180 rd. Honte Avret ue <br /> Rialtc.. ;A 92M <br /> Fadfi sPlone'. - r• <br /> ge, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.10 Number. 10.Containers 17.Total r 12.Unit 13,Waste Codes <br /> HM 7,and Packiig Group(8any)) - No. Type Ouenaty IM.NoI. <br /> Io?t A .B. ha::?Y vwi Waste. Sn-,!,d f� fit <br /> l,eAnt ' 1eY �3a, 1-;TS) I -- -- <br /> 3. <br /> i <br /> NOV 0 2614 1 <br /> 4. <br /> E , NEA T i <br /> 14.Special Handling Instructions and AdQifional Information " <br /> vy <br /> PRJB 5'21 )9731$1 One c le a of the material listed <br /> ccr em this ),ce, t r <br /> i oe recycled as alternative dally rover(ADC),a other <br /> EKI Jot #33892 method whip uses the material In or�q ,h�tn l (" <br /> IS. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by One proper shipping name,and are small packaged, <br /> marked and IabeloNplaarded,and are in all(aspects in proper condition for transport according to applicada international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I caddy that the conleMs of this consignment conform to the terms of he attached EFAAcknownedgment of Consent. <br /> I cw*that the waste minimi statement identified in 40 CFR 21 m I am a large pul ly generetor)or(b)(if I am a small quantgy generator)is true. <br /> eneral s' }�s PdnWyped�Nam Signi Month Day year- <br /> r�.'el r- ✓! C 'rl:t:.el'1 (IL (�Il. ._ �y lit ,.nom �1 �.'}• <br /> 16.International SNpmenls ❑ ❑ , I� <br /> F- Import to U.S. Export ham U.S. Pan of entryledr. <br /> Transporter sl nature for ex sonl : Dale loving U.5.'. <br /> W 17.TransporterAdknorl, "nam of Receipt of Materials <br /> fy, Tnanspater 1 PPnnd7ryped Nr° (` g ay ear <br /> QTransporter 2 Pnnlectryped Na(��:e gn ^ oamoral Day Tear <br /> r— <br /> • 18.Discrepanq <br /> Its Discrepancy Indication Space Ovanfity ❑Type ❑Rescue ❑Partal Rejection ❑Full Rejection <br /> Mandest Reference Number. <br /> fall.Alternate Facility(or Generator) U.S.EPA 10 Number <br /> FILTER RECYCLING SERVICES' RI LTo FACILITY, EPD <br /> I Faa1 sPhone LICA I <br /> W 18c.Signature of Alternate Faviity(a Genemiti ~ �, r r:w. (J Day Year <br /> AND WILL ACCEPT THIS WASTE AS SHIPPED. <br /> h19.Hazartlous Waste Report Management Method Codes 0.e.,codes fa hazardous waste"aliment,disposal,and recycling systems) <br /> 0 1 2 3. .. .-.. - 4. <br /> 20.Designated Fadliry'Ownw or oper Ceri fcation of receipt of hazardous matenals covered by the man t xcept as hoped i Ism 18a <br /> PrintedlTyped No j�. S' Nr - N Day <br /> ' �Yeer, <br /> � N (C f <br /> EPA Form 8700-22(Rev MS) Previous editrons are obsolete DESIGNATED FACILITY TO GENERATOR <br />