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N <br />�f <br /> F <br /> NON-NAZARDQUS 1 Generator's US EPA 10 Ne Mmniff 2 Pogo 1 <br /> Ill TE MANIFEST of <br /> 3 Generator's Name and Mailing Addreu <br /> CIRCLE K STORES ATTN; TERRI BREEN <br /> 1500 N. priest Drive, DC-40 <br /> 602 ' 728-4611 <br /> 5 Transporter 1 Company gams a L13 EPA ID Number A Transperter's Phone <br /> Filter-- RecyclinjZ services Inc. Q A D 98, 909)873-4141 <br /> 7 Transporter 2 Company Nome 8 US EPA 10 Number B Tronsportar's Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facdrty's Phone <br /> Filter Recycling Services, Inc. (9p9}421-2022 <br /> 180 W- Monte Avenue <br /> Rialto, CA 92316 CA ❑ R & 2, 444481 <br /> I 1 Waste$hipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type QuaMr Wt Yo1 <br /> a Non-Hazardous waste solid (soil) � ; <br /> 22 1 C <br /> f3 6 <br /> E <br /> !Y <br /> E <br /> R <br /> A c <br /> T <br /> G <br /> Ii <br /> d <br /> D Adrtional Doscnptions for Materials listed Above E Handling Codes for Wasies Listed Above <br /> 11a loll PROFILiE# 01062$36 <br /> / viol <br /> 19 Special Handling Instructtons and Additional Information <br /> Wear appropriate protective clothing Circle K Store# 2708671 <br /> 24 Hour Emergency Response # (909) #21-2038 8606 Thornton road <br /> Stockton, C'Q.S loq <br /> L acic,a Pow-W + M D — OUTA"Vap� <br /> 1e GENERAWS CaTIRCATION I c*rhfy inassnals described abow oa this monifett aM nal ee to federal regulations for roparnng ptoper disposal of Hacordws Waste <br /> r rte NameSig to month Oa=::-_ t:L' 1'aor <br /> aIg 4 -A< V21 / <br /> R 17 ec <br /> Tran rt r 1 Acknowledgement o4 eipi of Matenals <br /> A Pnnt d! ed Name Signature pgyi ec <br /> s l'1r1� 5 Cel <br /> �P <br /> IR Transporter 2 Acknowledgement of Rscsi r of Materiak <br /> T Printed/Typed Name Stgnarirs \t��� `nt0�1 trayYear <br /> h <br /> 19 Discrepancy Indication Space <br /> Q <br /> S+00 <br /> F <br /> A <br /> C <br /> I <br /> L 20 FaeilitY Owner or dporatar, Cartifieation of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> I <br /> T <br /> v <br /> Printed/Typed N Seg use Month Day year <br /> r <br /> ORtatNAL-RETURN TO C,EN£RATCR <br /> 60 39Vd OAS DNI-IOAD36 H311Id 889TIZV606 ET OT E09Z/VZ/ZT <br />