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Smfe crC .6,..—Emironmenrol Nau"'ian Agency <br /> Form Appro,ed OMB No.2050-00391Expir..9.30991 See Instructions on back of ; 6_61Department al T..,Sut,,,,.,. <br /> Please print or type. Form designed for use on elite 112-pitch)typewriter. So,,rini Can,ar-.: <br /> era 7 US EPA No. ani est Document No. ge i information.n she had .,car <br /> UNIFORM HAZARDOUS is not reau,red by Federal Ia. <br /> WASTE MANIFEST 2 0 5 2 3 1 7 8 3 7 °( 1 <br /> 3 Generator's Na...nd Mailing Address -Slate Manifest Document Number 99 17 8 3 7 <br /> USA Gasoline Corporation Attn: Chuck Miller <br /> 0 30101 Agoura Ct, Ste 200, Agoura Hills, CA B. Slate Generotoe,ID <br /> h Genemmr s Phone 181 8 18 6 5-9 2 0 0 91 301 <br /> w t 5 LanW.n<.1 Company Nvme 6. US EPA ID Number C. State Tmnsporlar'v ID(Reserve .f <br /> o C A D 2 7 <br /> S 8 3 6 5 3 6 D. Transport.,'.Phone 4 <br /> o� I WM Inc. B- US EPA ID Number E. Slate Transporlei s ID(Rase <br /> T•.mp.rmr 2 Company Nanta <br /> F. Transpoeer's Phone <br /> a AUG 4 2002 <br /> V� FTter <br /> Focality Name n)Site Address 10. US EPA ID Number G..$lab Fociliy's ID <br /> 1i! Filter Recycling ServicesI <br /> 4: <br /> 180 W. Monte Avenue H. Facility's Phone I <br /> _oRialto, CA 92376 IC IA P 19 18 12 14 14 4 18 11 909-Q)jAMiV3 RVICES <br /> I 1 U$DOi Desuiplion linduding Proper Shipping Nome,Mozmd Class,and ID Humbert 12. Container 13. Total 14 Urn <br /> 7U No. T e Quantity WUVoI I. Waste Number <br /> a Non-RCRA Hazardous Waste Solid Est StO1e 352 <br /> x <br /> 3 G 01011 D I M 1 131010 P EPA/Other n/a <br /> O�I E E State <br /> as <br /> a? E EPA/Olher <br /> c. R <br /> v A <br /> O T r Stale <br /> m O EPA/Other <br /> R <br /> w d Slats <br /> Z <br /> bu EPA/Other <br /> V <br /> cal3. Additional Descriptions for Mblarials killed Akovm / K.Handling Codes For Wastes listed Above <br /> a. 6. <br /> of 11 .a. Waste Approval' #02062125 i <br /> o d. <br /> Mt; k <br /> Q, a. <br /> Z <br /> I S Special Handling InwvcYom and Addlnanol I°lormmmn <br /> Wear appropriate safety gear SITE: USA #835 <br /> Z; when handling materials. 2705 Country Club Drive <br /> _ 24-Hour Emergency 408-942-8955 Stockton, CA <br /> to GENERATOR'S CERTIFICATION: I hereby deal...that the eonleats of this ccur ignmenl are fully and accurately described above by proper shipping name and are classd.ed oc,u, <br /> Q marked..rill labeled,and are in all respects in proper condition for transport by highway according to applicable imernalional and national government regular o,: <br /> V <br /> II I am o large quantity generator.I certify that I have apogram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be erne.-:o <br /> a pmnicable and that I have selected the practicable methods treatment,storage,or disposal currently available to me which minimizes the present and future threat to m., . <br /> u` and the eb.a.m.enl;OR, if I am.,.all quantity generator,1 have made o good faith effort to minimize my vemte generouan and sated the best waste management mime. <br /> .,..table to me and that I.nn afford. <br /> O "– <br /> )_ Printed,Typed Nome Sig M.nm Ddv <br /> Z om DeLon for Chuck Mi11er,USA f 0 7 10 ' e, -2— <br /> T <br /> LT 17 Transporter i Acknowledgement of Receipt of Materials <br /> w 4 Primed/Typed Nome Signalur MOnth <br /> P .;A t �U 0 '7 <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Moted.1s <br /> O APnmed,'Typed Name Signature Month <br /> 1 <br /> w E <br /> R <br /> V19. Discrepancy Indications Space <br /> Z F <br /> A <br /> C <br /> I <br /> ( 20 Facility Owner or Operator Certification of recap i of hazardous moteriols covered by This manifest except as noted in Item 19. <br /> T panted/Typed Name Signalure Month Da. e.:. <br /> T I I <br /> DO NOT WRITE BELOW THIS LINE. <br /> it. . . .. <br /> DTSC 6022A II/991 , - <br /> ia . .. - <br /> EPA B700-22 <br />