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Please print or type.(Form designed for use on elite 112-pitch)typewriter.) Forrn Approved.OMB No.2059.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 12.Page i of 3.Emergency Response Phone .Manifest Treck ng umber <br /> WASTE MANIFEST C A L 0 0 0 2 9 0 7 6 0 1 1-$0Q-424-9300 0 3 4 1281 JJ K <br /> 5.Generator's Name and Mailing Artdress Generatafs Site Address(i(di&erent than mating address) <br /> Coops Collision of Tracy Cooks Collision of Tracy <br /> 1104(lain St 2830 Auto Plaza Or#110 <br /> Redwood r ty CA 93304Tracy CA 95304 <br /> Generators Phone: R (; _ 0 <br /> S.Transpoder I Company Name U.S.EPA ID Number <br /> Environmental Looistics, Inc. IC A R 0 0 0 2 1 7 5 1 3 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> S.Designated Facility Name end Sile Address U.S.EPA to Number <br /> Filter Recycling Services,Inc. <br /> 190 W.Plante Avenue <br /> Bloz,ningtcn CA 92316 <br /> Facili sPhone: 909 4 - 1 C A Q 9 8 2 <br /> ga. 9b.U.S.DOT Description prddding Proper Sh pping Name,Hazard Gass,ID Number. 10.Containers 11.Total Q.Unit <br /> Hid and Pacfctng Group(if any)) No. Type Ouanaly WINoI. 13.1Vas�Codes <br /> 10Ion-RCRA Hazardous M-Aste Solid(BondD Dust) <br /> 252 <br /> 0 1 <br /> 2Non-RCRA Hazardous V bste Solid(Empty Paint Cans) 352 <br /> 3 Dtvl S'b P ...,... _... <br /> 3. <br /> 4. <br /> K Special Honoring[whanm andAddigonal Infamalbn 1)(S)8onda`Dust- 16011807 2)(S)Errrpty�� aS - 15022010 M#42375-N <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I herebydedare that the contents of lhls eonslgnmant are fully and accrealelydascnted above by the proper stepping name,and are dassded,packaged, <br /> marked and labelaplacerded,and are In allrespects In proper cord t on for transport according to applicable Intarnatonaland natonalgovemmenlal regulaEons.If export Wprr:enl and 1 am the Primary <br /> Exporter.I certify that the contents of this constgnment conform to the terms of the attached EPA Admordedgmenl of Consent <br /> I certify U,al lha wade min'rnizaOon statementfdentihed in 40 CFR 282.27(,)(il t am a farge quanbly generator)of(b)(ii l am a smell quantity generator)is We. <br /> GeneratoerjOo s,Prialed/TypedName Sgnature , Martth Day Year <br /> ter✓ <br /> 18. <br /> Internawal Stipmeats ❑import to U,s, ❑ try' <br /> po F.,�oR$omU.S. Porlofen !exit: <br /> Transporter signalure(fgr.exp"—OLI1y):_._ Date leawing U.S.: <br /> 17.TransporterAO meiedgmenl of Receipt f Matedals <br /> Tran pater 1 PWedn`ped Name ignam ldortdh Day Year <br /> 3 126 HS <br /> Transporter 2Printed yped Name Signature Month Day Year <br /> 13.Disuepanoy <br /> Iea.oiscrepancy Iadwion Spew —1 Ouaniry ❑Type <br /> El Residue Pa t al Rejection ❑Fu!I Re;ect cn <br /> Manifest Referents Number: <br /> 18b.Ailernate Fao-4ty(o(Genefalor) U.S.EPA]])Number <br /> U <br /> u. Facdiys;Phooe: <br /> 18c.Signature of Allemale Facility(M Generates) Mwdt Day yggr <br /> 19.Hazardous waste Report Management loledad Codes(Le.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> 3. 4. <br /> 20,Designated Factily O.vnef or Opemta:CertrBcation of receipt of hazardous materials covered by the manliest except as Aoled in Item 13a <br /> PdntedrfypedName Signature Month bq tar <br /> EPA Form 3700-22(Rev.3-05)Previous editions are obsolete. �. g , <br /> =3 ST 1' <br />