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Please.pdnl a type. Form designedloruse on e0te(12-pitchtypewriter.) Form Approved.OMR No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1:Ganmator ID Number 2.Pagan of 3.Emergency Response Pham - 4.Manifest Packing Number <br /> WASTE MANIFEST CAL000310282 1 800.72'1-2039 004849788 JJ K <br /> S.Genaratoh Nacre and Maifng4Mress Generator's SffeAddress(11 different than mating address) <br /> SAFEWAY,INC SAFEWAY 2707,6445 N PACIFIC AVE <br /> 44117 Ra9EW000 DRIVE VFOCKTON,CA 95,207 <br /> NL"EASANCON.CA 04588 <br /> Generators Phone: no.A7,).nwyj <br /> G.Traspcnar 1 Company Name U.S.EPA ID Number <br /> ENVIRONMENTAL LOGISTiCS,WC CAR000172478 <br /> 7.Tmrepona 2 Company Name - U.S.EPA ID Number <br /> 8.Designated Fad'Ay Name and SIIeMdmae U.S.EPAID Number <br /> Fit TER RECYCLING SERVICES,INC. CAD902444481 <br /> 190 W.MON-rE AVE <br /> RIA1.T0.CA 02316 <br /> Fadalys Phone: 909.421-2012 <br /> ga 9b.U.&DOT Desgiplion(ncluding PraperShiyping Name,Hazard Class,ID Number 10.Contalners ti.Tolal 12.Unit 13.Waste Codes <br /> HM and Padang C1mup(gany)) No. Type Quality Wtivol. <br /> 1' NON RCRA HAZARDOUS WASTE SOLID DM ((,: P 352 <br /> aO <br /> -7- <br /> 2! <br /> =w 2 NAAJ-HC-RR-ht4F�R:]r3it8-W&a'IF:JdC:td10 CH41 3••.. .S`S'4• <br /> cg <br /> 3. <br /> 4. <br /> 14.Special Handling ImbucSas and Additional fniormation <br /> 9.81)ABSORSF.NT wFIL rERS'#V2120605 a' k � ti WEAR APPROPRIATE PFE lNVdf 46413 <br /> BBaiWAVf PA'Wgq 1;: l,?A=7A4— One or more;of the material llpiupO>tbis;miidfiSt-may <br /> ' .. .. tie racycte4'as alt maU¢h dah4 cpver,(ADC),ar gther <br /> method which us�s a aterfai4n di�g7r jhd land <br /> 13. OENERATOR51OFFERORS CERRCATIONr i herehydedare thatthe contents of this mwipment me'My and accurefeydowfibed.above byte proper ahgping name,ant are clasatled,packaged, <br /> marked end lebeledlpecerded,and are in all respects in propwwndtion fortranspont according to applicable immalionzland nOmal governmental regulatlona.Mexportshlpmantand I am this Primary <br /> Expoder,I qtly get the contents elide consignrrentmnfurm to the tans of the attached EFAAdmowledgmentof Consent <br /> I certifyTalthewame minim7atim statemem idm Plod in 4o CFR 2a227(a)(f i am a Imge quantilygenereta)ar(b)(gl am asmal quanliy genbmtor)is bu& <br /> Generatoft*ffarah Pdnletlliyped St mum Month Day Year <br /> —itB.at6medonal Shipments ` <br /> Impalb U.S. ❑Egad Imre U.S. Port W emrylaxlt <br /> Tmaspoder slimlum(fa exports only): DatelemInq U.S.: <br /> 17.Transpo"Atlmovdedgment o(Recelptof Maledals <br /> F- Transporter 1 Pmted!(yped Name Month Day Year <br /> n a _ +tet ��� I.\ �'` 1 ( % /; ,C {��y t✓�ti. . <br /> t..�'r.' <br /> Transporter P.dmedf(yped Name SlgnaAue `- r Month Day Year <br /> f <br /> 1&Dsaepancy <br /> tike.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Re)ection El Ful Relacion <br /> V?a <br /> Manifest Reference Number. <br /> IBb.Alienate Fadfty(orGenerator) U.S.' EPA ID Number <br /> FILTER RECYCLING SER'1 ES` RIALTO FACILITY, EPA <br /> LL FadllysPhas: #GAD982444481 H.A.— THE *"DROPRIAT PEE)MIT(S) FOR, <br /> 18c,SNnahn ofAllamate Facility aGene Dior) AND V,/U. ,A!�;'E:IDT THIS WASTE AS SHIPPED. Month Day Year <br /> a <br /> be <br /> S2 19.Haanduus Wame Report Management Method Codes(I.e.,codes for hazardous waste bestme d,dsposA and ragdhg systems) <br /> 3. 4. <br /> 20.D&agnaled Fahy Omar orOpe Ia:CeffdcatlanofreceI4 ofhazprdws materials covered by the mmirest except as road In Item tea _ <br /> Pdnted!(yped Name \ - Slgmrure _ r,._,y Month Day Year <br /> EPA Form 8700-22(Rev.3-05) PrWouar edillons are obsolete. DESIGNATED FACILITY TO GENERATOR <br />