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_::: <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Page 1 <br /> 9Dogu7n1J1o0 of 4�2')I'004 ry <br /> WASTE MANIFEST J A <br /> Ghlvera r' Name and Mailing Address <br /> a ya es <br /> P 0 BOX 903 <br /> BORREGO SPRINGS, CA 92004 <br /> Iq 4 Generator's Phone( 888 ) 701-66003 <br /> r 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> FILTER RECYCLING SVS, INC -NO IC A R 0 0 0 1 2 9 3 0 4 (510)670-9901 <br /> 7 Transporter 2 Company Nome 8 US EPA ID Number B Transporter's Phone <br /> F1Iter Recycling Services, Inc C A D 9 8 2 4 4 4 4 8 1 (909)873--4141 � <br /> n a< <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone }r <br /> a <br /> Filter Recycling Services Inc , <br /> 180 W Monte Avenue {909}4�1-�01_ <br /> " Rialto. CA 92316 CAD 982444481 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit "a <br /> No Type Quanta Wt vol <br /> ,NON HAZARDOUS WASTE SOLID. <br /> s <br /> D M 500 P <br /> E <br /> E <br /> A e FiLTER RECYCUNG; S J h 3% <br /> ` o #CAD982444481 HAS THE APPROPRIATE PERM-11(S) FOR, r? <br />�� R � r •r. ��*;i` } ip CSTt� �i iir�l� - <br /> 1 d <br /> Ir <br /> (� kt <br /> D Additional Descriptions for Mater Is 1 Above E Handling Codes for Wastes Listed Above F_ <br /> r <br /> } <br /> 11ASOIL <br /> � is <br /> I j <br /> 15 Special Handling Instructions and Additional Information ; <br /> Wear appropriate protective clothing ADVANCED GEO ENV{QUICK & SAVE #2) <br /> 2507 S. ELDORADO ST ` <br /> I 24 Hour Emergency Response # (909) 721-2038 STOCKTON CA 95204 <br /> BILL SLABY SALES <br /> (� s <br /> 16 GENERATOR'S CERTIFICATION I Certify She materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hozardaus Waste <br /> t <br /> Printed/Typed Nome Signature Month Day Year r� <br /> M6tx�­� n 4r Sl 6_6 <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> NPrinted ped Name �/ t y� Signature Month Day Year <br /> I'-- <br /> s 7A-r, V'1 �kA4D A-3 17 3- <br /> pR 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> OR, <br /> x`x <br /> x 19 Discrepancy Indication Space <br /> F 3 <br /> A <br /> C �+ <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 h <br /> a <br /> Y <br /> Printed Type Signature Month Day Year <br /> t ra <br /> Pl" /1 '/ F /'erl;'10 GENFRATOR <br />