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Please print or type.,(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Gen,eralorIONumbet 2.Page 1 of 3.Emergency Response Phone 4.Monlfesl TracAing Humber <br /> WASTE 11911FES7 C A L 0 J 0 2 9 6 7 6 0 7 1-800 4L49300013482794 �9�'r� <br /> 5.GensralofsName and Ma1G Address Generator's Site Address(if diferenl than mailing address) <br /> Cooks Collision of�Iacy Cook.Collision of Tracy <br /> f 1104 blain St 2830 Auto Plaza Dr X110 <br /> Redwood City CA 95304 Tracy CA 95304 <br /> Ceneralor'sPhone: 9 1 8 7 8 B - 2 9 4 3 <br /> S.Transporter 1 Company Name U.S.EPA ID Number <br /> Environmental Logitic, Inc. IC A, 8 0 0 0 2 1 7 5 1 3 <br /> I i 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Oeslgnated Facaty Name and Sil*Address U.S.EPA to Number <br /> Filter Recycling Services,Inc. <br /> 180 W.Monto Avenue <br /> Sloorrington CA 92318 <br /> Facility's Phone:909 42J-20112 C A D 9 8 2 4 4 4 4 8 1 <br /> 9a. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(Many)) No, Typo Quantity W'Nol. 13,Waste Codes <br /> ELI 'Edon-RCRA Hazardous Waste Solid(Rondo Du t) 352 <br /> DM P <br /> z 2. <br /> LU <br /> 3. <br /> 4. <br /> l <br /> 14.Special HandiiaglnsWctionsandAddiGonallnformailon 1)(S)Sonda Dust-(415011507 WD 40700-N <br /> 1 1< <br /> 15. GENERATOR'SfOFFEROR'S CERTIFfCATION: I hereby declare that the contents of this consignment are fu^y and accurately desmrbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledfplecarded,and are in all respects In proper condition for Vansportaccording to app5cable Intemationaland natronal governmental regulations.If export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAckA&Medgment of Consent <br /> certify that the waste min'snizalion statement Identified fn 40 CFR 262.27(e)(if f em a large quantity ger etalor)or(bJ(91 am a smal quantity generator)Is live. <br /> y Generalors101� rintelly ad Name C Signalu Month Day Year <br /> Fa 16.nlernabonal Shipments <br /> Import to U.S. ❑Exportfrom U.S. Port oleniryfeAt• <br /> Transporter slgnature(for exports only): - Date leaving U.S.: <br /> LY 17,TrensporlefAeknoW.edgmentofReceiploffdaledals <br /> � TransporterlPgnted/lyped�eme Signature Month Day Year <br /> GTransporter2PrintedfTypedNamaSignature Month Day Year <br /> 18.Discrapancy <br /> 18a.Discrepancy Indiealion Spaea ❑Quant( ❑ ❑Partial Re eaon <br /> Y ❑Type Residue J ❑FuIIRe)ectian <br /> Manifest Reference Number. <br /> 16b.AIlernaleFep7ity(or Generator) U.S.EPAID Number <br /> J <br /> U <br /> Fadity's Phone; <br /> 0 16c.SlgnalureoAllemaleFaality(or Generator) Month Day I Year <br /> Q <br /> N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposer,and recycling systems) <br /> d 1' 4. <br /> 2D.Designated Facility Owner or0peralon Cedification ofrecelpt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PnntedrrypedName Signature Month Day Year r <br /> EPA Form 8700.22(Rev,3.05) Previous editions are obsolete. 7 I I <br />