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State of California—Environmental Protection Agency ._ <br /> Form Apple,ad OMB No.2050-0039(Expires 9-30-99) See Instructions on back Of Page 6. Department of Toxic Substances Control <br /> Please pried or type. Form designed far me on elile(12-pikt +wrihc Sacramento,California <br /> Senemlor's US EPA ID No, Manifest Document 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS _ _ is net required by Federal law. <br /> WASTE MANIFEST A of <br /> 3S9fSWAbNam$N jtMailing Address I A. Stalk Manifest Document Number <br /> 4410 ROSEWOOD DR. 24202864 <br /> o PLEASANTON, CA 94588 B. State Ganerator'sID <br /> rqq 4. Generator's Phone( 92� 94'4-4312 - <br /> N S. Transporter 1 Company Name 6. US EPA ID Number C. State Transpomer's ID[Reserved.] <br /> h <br /> M FILTER RECYCLING SVS, INC.-NO 9 D.Transporter's Phone 7 <br /> 0 <br /> °? 7. Transporter 2 Company Name 8. US EPA ID Number E. Stole Tronsporter's ID(Reserved.) - <br /> "It � I � 9 � � <br /> Filter Recycling Services IRC• PTranP <br /> oer's Phone <br /> U 9 e F Ile 10. US EPA ID Number G. Stale Facility's ID <br /> 'CV d FQiE'�'9� Ff�'�$l�nM3 tt"ices, Inc. 2 $ y Y Y I <br /> 180 W. Monte Avenue <br /> Z Rialto, CA 92316 C A D 9 8 2 4 4 4 4 S H. Facility's (909)421-2012 <br /> CV 0 <br /> .' 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description[including Proper Shipping Name,Hazard Class,and ID Number) Ai <br /> NU _S WASTE LIQUID No. Tye Quantity WI/Vol I. Waste Number <br /> Z a. Smt <br /> 134 <br /> 3 G 0101 D 0 4 5 G "119W <br /> o N b. 1 p Sm O <br /> AW00CO E <br /> v R o � D � r,� h b EP <br /> N <br /> 'a A c - Stale <br /> 6 T <br /> 00 O EPA/Other <br /> R <br /> w d. State <br /> wZ <br /> EPA/Other <br /> U <br /> m J. na p ns MisisIbils Listed Above - K. Handling Codes for Wastes Listed Above <br /> Z 11B) ABSORBENT / FILTERS <br /> N <br /> W <br /> Q b <br /> Z15. Special Handling Instructions and Additional Information <br /> 0WEAR APPROPRIATE PROTECTIVE CLOTHING P/U LOCATION:SAFEWAY ,4;2707 <br /> z 24 HR #909-721-20.73 6425 PACIFIC AVE <br /> w STOCKTON, CA <br /> 16. GENERATOR'S CERTIFICATION: hereby declare that Iha contents of this cansignmanl are Fully and occuralelyy described above by proper shippflag name and ore classified,pocked, <br /> < marked,and labeled,and are in all respects in proper condition for transport by highway according to opplica6la international and nationo government regulations. <br /> If I am o large uan,iy rotor,I cern that[have h roggram in lace to reduce the volume and toxicityf waste generated to the de I have determined to be economically <br /> a- praclicable and tkot lay.selected the pr dicoble method of treatment,storage,or disposal currently availble to me which minimizes Ike preseal and future threat to human health <br /> and the environment;OR,if I a a small quantity general.,,I have made a good faith effort to nimmnize my-.waste gereration and select the bent waste management method that is <br /> d' available to me and that I can afford. <br /> 00 d/T,ped Name Signature ,, Month Day Year <br /> U P i I C7p 2 <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> d' R im.d/Type ante �J SignoW a � Month Day Year , <br /> w R 'I T� <br /> w 5 �. <br /> LL 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 R Printed/Typed Name Signaler. Month Do Yeo <br /> A <br /> U19. Discrepancy Indication Space <br /> Z F l <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facile Owner or O armor CertiFicmi n of ra ei t of hazardous materiels covered b this manifest exce 1 os.noted in Ilam 19. <br /> T Printed/ Signature Month Day Year <br /> Y �`J E l e�I s / D ? o r t <br /> DO NOT W9ftE BELOW THIS LINE. <br /> Whit.: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) To: P.O. Box 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />