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r - <br /> NON-HAZARDOUS :=nwri;it.r':% LIS EPA ID No Manifest 2 Pagel <br /> WASTE MANIFEST <br /> Document No of <br /> ' 3 Generators Noma and Moiling Address <br /> CONOCO PHILLIPS ATTN. TERRI BREEN <br /> 15000 N Prlfdd 31L DC.ive, LZC-40 g <br /> t �'tr�L@grot�hc6�b�81 ) 728-463tT ....,.�..._. <br /> 5 Transporter I Compan me ad US EPA ID Number A Transporter's Phone <br /> Tronrler mpony ame US EPA ID Num er 6 Tronsportar's Phone <br /> ' 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> Filter Recvclinq Services, Inc. <br /> ' 12 <br /> 180 W. Monte Avenue <br /> (909) 421-20Avenue <br /> 11 Waste Shipping Name and Desaiptmn 12 Containers ~ 13- ld <br /> T Unit <br /> No Type Qypnti TWt/Vol <br /> Non-Hazardous waste solid <br /> Non,--Hazardous waste lictuid <br /> ' e <br /> A <br /> A c <br /> ' T <br /> O <br /> R <br /> d <br /> D Additional Descriptions for Matarnols Listed Above E Handling Codes for Wastes Listed Above <br /> Ila) soil Profile 01062536 <br /> ' 11b) watar Profile 01062537 <br /> I5 _Special handling Instructions and Additional Information <br /> ' 24 Hour Emergency Service 909-721-2038 Conoco Phillips #4400 VAr- JPrr '�57 <br /> 1502 N El Dorado Street <br /> WAR APPROPRIATE PROTECTIVE EQUIPMENT Stockton, CA <br /> ru'IALUL <br /> 1 <br /> 16 GENERATOR'S CERTIFICATION I certify the malenalf abov on this mamfesi are not sobled 40 fedefol regvlotiom for ailing proper disposal of hazardous Waste <br /> ' Printed/Typed Name 5lgnafur FA'1_r Monfh Any Yew <br /> .�� (Y"AN TILLIL b L4 : <br /> T 17 Trans ortar 1 Acknowledgement of Receipt of Motermis <br /> A rinted/Typed Name , Signature Month Dv Year <br /> ' S [Q J <br /> S <br /> p18 Transporter 2 Acknowledgement of Receipt of Materials <br /> Panted/Typed Name S gnofure MoAM Day Year <br /> 1 R <br /> 19 Dacrapancy Indication Space <br /> F <br /> C <br /> I <br /> E_ 20 Focd y Owner oe operator Certification of receipt of wane maserrols covered by this manifest aKcept as noted rn Item 19 <br /> f <br /> T <br /> Y T me $i8naf�re Month Day Y <br /> ' Printed/ yf4'T V V o <br /> I <br /> CRIGINAL - RE-URN TC GC1"F_R4T0R <br /> V0 39dd OAS 9N110A03d 839TTzb606 E8 bt sa90z/6z/b© <br />