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I <br /> Stan of Collforra—Environmental Protaclion Agency <br /> 'Form Apo MS No,1050-00391Expires 9-30.991 See Instructions on back o' )e b. Deportment of Toxic Substances Control <br /> 'Plea pr <br /> or.type. form Jevgned for use on efite(12-pihh, "it.r. Sacramento.California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST CAL Q O 0 2 0 5 2 3 1 7 8 3 7 5 of 1 <br /> 3. Generator',Name and Mailing Address SNMFfi F(FI. pOT� ' <br /> USA Gasoline Corporation Attn: Chuck MillerIr° ur9 91 Z s s 7 5 <br /> 30101 Agoura Ct, Ste 200, Agoura Hills, CA dusld gas,, <br /> h a. Generator's Phone 18 91301 �i ` R 41yg <br /> n <br /> tW 5. Transporter 1 Company Name 6. US EPA ID Number <br /> a� ' <br /> o IWM Inc. CAD 91813161513161217 �9}F �; 42-8955 <br /> C? 7. Transporter 2 Company Name 8. US EPA ID Number <br /> a"150 W rY' <br /> Feu t-M !2Cta tiG f\.6 Itac D I _ Z <br /> Y M ryF e{ MNY1W � <br /> 9. signaled Facility N e nd Sit.Address 10. US EPA ID Number G%{Slpla Iqt:` YjTws yx, <br /> ('')Q Fi�ter Recycling Services 1T4AM, A.VAIAVI al <br /> CC)2 180 We Monte Avenue a. <br /> rvgill F R o-rC x r <br /> I` o Rialto, CA 92376 1 C JA P 1918 12 1414 1418 11 _ rt x909'18'73-41 41 <br /> J11. US DOT Description lincluding Proper Shipping Name,Hazard Class,and ID Number) 12 Conminers 13. Total 14. Unit - <br /> V No Type Quantity Wt/Vol I. Waste Number <br /> a)= Non-RCRA Hazardous Waste Solid Est st°I' 352 <br /> 3 G 00 ( D M1 13,C O p EFA/Oher n/a <br /> o N b. Slate <br /> m E <br /> v R EPA/Other <br /> v A c. <br /> T Slate O <br /> W <br /> _ R EPA/Other <br /> tin <br /> w d. Sime <br /> t— <br /> Z <br /> w <br /> V EPA/Other <br /> w _ <br /> Z j.,Addthangl DescRt „�.(a}veyfete$,: $ A r ?' y., ' ' `- , ' NandPrgg Cpd.s(grWayes Ust.d Above <br /> 1 a Ws kPxoaa w / b, <br /> Q r�u,:tRa�- °x- ih iii 4 r ?t±'s A.;-c'.. <br /> 15 S eu.I Handling Iry and Additional Information P 9 `I31 L 1- 1-0 I t.w lvi (1 A�-P1Td 3 <br /> I:= 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 /> Q <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this comig' ealare fully and accur°lely described above by.......hip ing namand a ,I.s,J..d,packed. <br /> V marked,vad labeled,and are to all inspects in proper condition for transport bymhighway according to applicable international and nmianaPgove re <br /> isomers regulations. <br /> J II I am°large quaaliy 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 economicallyy <br /> o- practicable and thal I Gave selected the aclicoble method a treatment,storage,or disposal currently available to me which minimises the present and[.lure threat to human hauls <br /> and the environment;OR,if I am o smo I quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O <br /> woilable 1. no and that I can aF ord. <br /> y Printed/Typed Name Sig Month Day Year <br /> Z ons Delon for Chuck Mi11er,USA t 11 7 O t Z <br /> w R 17. Trans oder I Acknowled amens of Receipt of Material, <br /> w A Primed/Typed Name Signator Month D Year <br /> w P JAM s tU o7G 3C. z <br /> 0 10. Trons aver 2 Acknowledgement of Receipt of Materials <br /> O ! Pri red/Typed Nanta Signoture Month Day Year <br /> xrcOilio 3 10 <br /> V 19 Discrepancy Indication Space <br /> Z E <br /> — A <br /> C <br /> I <br /> L <br /> 20. Facility Owner or Omer for Certification of receipt of hazardous materials covered by this manifest except a,noted in Item 19. <br /> j 1 Printed/Typed Nome SignaNre Month Day Year <br /> T S d70941d � <br /> DO NOT WRITE ELOW THIS LINE. <br /> DISC 8022A (1/991 White. TSDF SENDS THIS COPY TO DT; <br /> EPA 8700-22 To. P.O. Ea. 3000 Sacramento. C. .._ _ <br />