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<br /> Pleb print or*..iForm it*igned form on Ilte(12-itch)typewriter.) Form Approved,OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1.Genemmr ID Number 2.Page 1 of 3.Emergency Response Phone 4.Merrillng Number
<br /> WASTE MANIFEST r-_. a. 1- n ,^ r; o, , 171 f, ,, 1 500t-424-03U., 014445534 J J K
<br /> 5.Generators Name and Melling Address H,t, �X=seen Pin+.@I!r_. Genemora 4 real ndiffahm lien mailing address)
<br /> c•ate':a ire_ aie,•vayStore
<br /> 5-9.i?,Stonandje Miall PI 64A' Facfic 4',-
<br /> Fleasanten CA W-2 Stoc!+ten C;v @52F17
<br /> Generalities Phone: , o r?- - _ ,
<br /> B.Tmnspo,0ar psny ems U.S.EPA ID Number
<br /> En•,ir-onrnerrtal LogiAies, Inc '- w R o o o -21 7 5 T S
<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number
<br /> Filter Recycling Servicers,ir�c.
<br /> l80W 0.l�nte tiuerv=
<br /> Sicorr ngton 92315 ��"
<br /> Fail sPhorh: i,lu :,I--+f . 1 A R -1 ' _
<br /> Is, 9b.U.S.DOT Deacdp8on grouting Proper Shipping Name,Hazard Claes,ID Number, 10.Conlelnem it.TOW 12.Unit
<br /> HM and Pecdrg Group(f any)) t3.Waste Codes
<br /> No. Type Oue W WWoI.
<br /> 1 UH3175 Sc3ide Qenmining lla mTable liqu!d,n.os,(pasrdiesel fikcr« z
<br /> ryD'_2,aI= fi�ol6�•aF.avaay=,4 ! F'�I!I -
<br /> �
<br /> Z 2.
<br /> w
<br /> ,
<br /> FILTER REO;G:I
<br /> 1a,Spegiel{{gtdfiW lr,almplcme. . a(N. too - . - _.._ _
<br /> '1111 f�"ds!�@ieSufl Filters.'hcses.nozzels,hots breakas'rdyg-i t0'21'A1'C-Rr,#1='3 .. .. .._.
<br /> 15. GENERATOR'SIOFFEROR'S CFRTIFICATtON:I hereby declare that Ne coments of ths mr signmentare fully and accurately described above by ane proper shipping name,and are deatifiec,packaged,
<br /> marked and Iabelediplacarded,and am in all respects In proper condition for transport acoording to apploable international and national governmental regulations.If export stilmentand I am the Primary
<br /> Exporter,I on*that the contents of this consignment conform to the lams of the aaached EPAAcknowiedgmenlof Consent.
<br /> I tartly that the waste minimUation statement identified In 40 CFR 28227(x)(f I am a large Wantity,ger,emtor)or(b)(til small quantry generator)is true.
<br /> cm r&eslofemes PdnteORed Name ypSignature Monts Day ear
<br /> X 1. ; c
<br /> L � v fG ' -r
<br /> o.international Ipme,rta L�l
<br /> i
<br /> LJ mw to U.S. ❑E-oodfmm U.S. Pad ofentylexg: _
<br /> Transporter signature(for axports only: Dab@ leaving U.S.:
<br /> 17.TmnspodarAdwMedgm Rtof Remlplof Melerlals
<br /> Trion ner 1 d --�
<br /> C/sP° YPed�nh Sign Momh Day Yeay
<br /> h Al � , f 41
<br /> mnspodx FmltefTyp8KJ Name Slyeture �' Mara Day Year
<br /> 18.Oeaepancy
<br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Resdue LlPanel Rejection DWI 4sollon
<br /> Mai Reference Number.
<br /> 18b.Ater,ete Fedtry,(or Generator) U.S.EPA ID Number
<br /> LL Faclltys Phone:
<br /> 18c.SsgnaWmo mate Factay or Generator Month Day Year
<br /> 19.Hanmous WaetIrRepolt Management Method Cotler(i.e.,codes for hazardous walla treatment,disposal,and meyding systems)
<br /> G 1. 2. 3. 4,
<br /> 20.Designated Facility Owner or Operator:Cerdiketbn of miceipt of harardous materials covered by the manifest except as nded in Its Se
<br /> Printecirryped Nan 4ignaw h ear
<br /> L
<br /> EPA Form 8700-22(Rev.3-05) Previous (tions am o l
<br /> _ e . DESIGNATED FACILITY TO GENERATOR
<br /> ss: _.
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