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ti <br /> � �tl <br /> I ( enerator's US EPA ID No Manifest 2 Pogo 1 <br /> �ON-HAZARDOUS <br /> WASTE IEE T °} 1 12116 2003 <br /> 3 Generator's Name and Mo+hn Address RALr:3�� <br /> CQPJ000�1fiILLJPS A : <br /> 776 BROADWAY <br /> 1 enerator s hoX (CA 95115 <br /> SSA-7633 <br /> S Tronsparter 1 Company NamO 6 US EPA ID Number A TronspoRer's Phone <br /> FILTER RECYCLING 9VS, INC--NO IC A lir a 0. 0- 1 2 9 3 0 4 (510)6'77(0)-9901 <br /> 7 Transporter 3 Company Name a US EPA ID Number B Transporters Phone <br /> H a N. 1K (000)000-0000 <br /> 9 Designated Facility Name and Site Address 10 U5 EPA ID Numbar C Facility's Phone <br /> Filter Recycling Services, Inc. (909)421-2012 <br /> 180 W. Monte Avenue <br /> Rialto, CA 92316 IC A n 9 8 2 4 4 4 4 8 1 <br /> 12 Containers 13 lA <br /> 11 Waste 3kippmg Name and Description Total Unit <br /> No Type Quantity Wt Vol <br /> a~ NW WARDWS WAM LIQUID - <br /> c v aKJ A C:-,,�' <br /> E 6 <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> d <br /> `� p11gA���gppi Deccrrpt�q,� q/+1pt r�i ve E Handling Caries for Wastes beted Above <br /> yM so I ago <br /> Special Handling lostr ctioos and AdclOsepol Infer oto <br /> ear appropriate protective c`�ot ling P/U LOCATION. CONOC`T ORNT <br /> $60f '1',lii7RNTON RD <br /> ST(}CKMN, CA <br /> 24 Hour Emergency Response # (909? 7212038 q_Q_() 4 <br /> 14 GENERATOR'S CERTIFICATION i cer,dy Thi n ofiif.ak d"eribed abo•e on this mamfaat ars not wb+se to 440ra1 ,egulations for reporting proper dwpoeal at Noto.bovt wove <br /> Printed/Typed Nome Signature Month Det, yoer <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A Pr d/Typed Name tui Month Day Yeer7 <br /> 6itCSC4� 7o^', �.�'— -�� .� l <br /> P 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> i <br /> T Pnntod/Typed Name vture Manch Day ion. <br /> E <br /> 1i <br /> 19 Discrepancy Indication Space <br /> r <br /> A <br /> 1L 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> T <br /> Pr+r+ted/Typm $tgnoture Month Day Year <br /> x of 0r0 710 Y <br /> _0L GE�4FRAr,�P <br /> Z0 39Vd OAS 9NIIOA33�1 833-lIJ 88SITZV606 TO /T ti00Z/10/10 <br />