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NON-HAZARDOUS 1.Generator ID Number 2.Page1 of 3.Emergenq Response Phone 4.Waste Trecldng Number <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailing Address 141-147871 <br /> KING ISLAND RESORT Generators one Atltlress(N tliHerent than mailing s) <br /> 11530 W EIGHT MILE ROAD <br /> STOCKTON,CA <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ENVIRONMENTAL LOGISTICS, INC CAR000172478 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Desi9noted Facil'dy Name and She Address U.S.EPA 10 Number <br /> FILTER RECYCLING SERVICES,INC. <br /> 180 W.MONTE AVE CAD982444481 <br /> RIALTO,CA 92316 <br /> Facils Phone: 909.421-2012 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit <br /> No. Type Ow n6ry Wt.Nol, <br /> a 1' NON HAZARDOUS WASTE SOLID 2O DM JJ p <br /> a <br /> W <br /> 2' NONHAZARDOUS WASTE LIQUID <br /> 2-Z) /00()/O� G <br /> 3. <br /> 4. <br /> 13, Special Handling Instructions and Additional Information <br /> 9B1)SOIL#08082808 7-0x � WEAR APPROPRIATE PPE INV#47621 <br /> 982)WATER#08082807 2,L>l SS <br /> BILL TO:EXCELL <br /> 14.GENERATOR'S C RTIRCATION:I certify the materials described above on this manflesl am not subject to federal regulations for repo 'g pro of Hazardous Waste. <br /> Generatorsr00erof nnteMypeof Name Signe - Month Day Yeaz <br /> v, i � .cc d� 6 6 <br /> 15.International Shipments <br /> F ❑Impart to U.S. LJ Export from U.S. Port of en zit: <br /> z Transporter Signature for exports only): Date leevin U.S.: <br /> ¢ 16.Transporter owledgment of Receipt of Materials <br /> , <br /> T�ra)nsporter 1 Pr tetl/lyped Name Sig ure Month .Day Ye r <br /> 6 C>t_ Tim <br /> LlT (.(l <br /> Transporter Printmlyped Nae SignaNre Month Day Year <br /> F <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantity E]Type El Residue ❑Partial Rejection El Full Rejection <br /> T 17b.Agernete Feciliry(or Generator) Manifest Reference Number. <br /> tJ FILTER RFCYCLING SERVICES' RIA,I TUS.9PAI?Thim (wR <br /> v <br /> LL Facility's Phone: #CAflCi;"%: <br /> 17c.Signature of Alternate Facility(or Generator) <br /> Month Day Year <br /> z <br /> O <br /> N <br /> W <br /> O <br /> 18.Designated Facilly Owner or .peratoc Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> Printed/Typed Name Signature Month Day Year <br /> �� OO <br /> 769-BLC-0 5 11977(Rev. 106) DESIGNATED FACILITY TO GENERATOR <br />