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SIuPo of Ca'fif.m ia—Environmental Protection Agency <br /> m Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back _ `age 6. Department of Toxic Substances Control <br /> rmase pant or type. Form designed(or use on elite(12-F ®wrilec Sacramento,California <br /> Utv1Ff7RRfi HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST01010121at is nal required by Federal law. <br /> CAL 8 0 7 6 8 9 8 22 <br /> 1 <br /> IQenerator's Name and Mailing Address A.stale Manifest Document Number 2 3 5 5 3 7 5 <br /> EWAY, INC. <br /> 2800 YGNACIO VALLEY RD <br /> h WALNUT CREEK, CA 94598 e: Slate ceneratore 11) <br /> 4. Generator's Phone 1 925 1 944-4312 <br /> N 5. Transporter I Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.I <br /> h <br /> 00 o FILTER RECYCLING SVS, INC.—NO CAR 0 0 0 1 2 9 3 0 4 D. TmnsParter'sPhone (510)670-9901 <br /> 0 <br /> a? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved] <br /> L1"9— <br /> (`v Q 1 1 p G ( G F. Transporter's Phone <br /> �U D signaled Facilily Na q and Sine Addr g IIO. Us EPA ID Number G, State facility's ID <br /> M d �'ifte.t Recycling Se ices, Inc. <br /> Lr)of180 W. Monte Avenue H. Facility's Phone <br /> Rialto, CA 92316 C A D 9 8 2 4 4 4 4 8 1 (909)421-2012 <br /> Q <br /> 11. Us DOT Description)including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> CV U No. Type Quantity Wt/Val I. Waste Number, <br /> z RCRA HAZARDOUS WASTE SOLID 5i3152 <br /> — _._ E <br /> 3 G-- — __ ...-.__.. . _ D M P <br /> o N b' N_ Xf4Z}} 7�40L1JS Li 511 stat, Z. <br /> m E <br /> N R <br /> A C. lJ Sate <br /> o T <br /> co O EPA/Other <br /> R <br /> a <br /> w d. stem <br /> F <br /> UEPA/Other <br /> w <br /> � 1: Addilipna10escriplions.far Mol.ripls Listed Above ^� -. K. Handling j odes kr Wastes listed Above <br /> 11A)ABSORBENT 03��JC(D a. I��D, b. O / <br /> w 118) pkuet:-e, <br /> a <br /> z 15. Special Handling Instructions and Additional Information <br /> WEAR APPROPRIATE PROTECTIVE CLOTHING P/U LOCATION:SAFEWAY #2707 <br /> z 24 HR #909-721-2038 6425 N. PACIFIC AVE. <br /> STOCKTON, CA. <br /> x <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and 1.6.1.4,and are in all respects in proper condition far transport by highway according to applicable international and national government regulations. <br /> -' If I am a large quantity generator,I certify that I have a proggrom In place to reduce the volume and toxicity of waste generated to!her degree I have determined to be economically <br /> a practicable and that I have selected the Practicable method al treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> `O and the em,ircimeni OR,if I am a smaquantity generator,I have made o goad failh eff ut la mini y waste generation and select the best waste management method that is <br /> ac available to me and that I c..afford. <br /> O P d/Type Nome no <br /> Month Day Year <br /> w 1 17. Trans over 1 Acknowled .m..t of Receinpi Materials <br /> c p Printed/ ped Name Signature Doth Day ^^Year <br /> w <br /> S S z U <br /> a18. s over 2 Acknowled emeni of ecei t of Moteriols <br /> 0 i Printed n ped Nanta 8ignoNre l n, ay ear <br /> w E <br /> n <br /> It <br /> Vcreponcy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facilin,Owner or Operi Certification of reoept of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Punted/Typed Nan Signature Month Day Year <br /> y J S LLJ <br /> DO NOT i BELOW THIS LINE. <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 PAYS, <br /> DTSC 8022A (1/991 I. P.O. Box 3000, Socr.menio, CA 95812 <br /> EPA 8700-22 <br />