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NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tmcking Number <br /> WASTE MANIFEST 1 909.721-2038 NH47871 <br /> S.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> KING ISLAND RESORT <br /> 11530 W EIGHT MILE ROAD <br /> STOCKTON,CA <br /> Generators Phone: 949-233,2789 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ENVIRONMENTAL LOGISTICS, INC CAR000172478 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.De' nated Facll�'ty Name and She Addreas U.S.EPA ID Number <br /> FPLTER RECYCLING SERVICES, INC. <br /> 180 W.MONTE AVE CAD982444481 <br /> RIALTO,CA 92318 <br /> Facil' sPhone: 909.421-2012 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12,Unit <br /> No. Type Quantity WtNol. <br /> 0 1. NON HAZARDOUS WASTE SOLID let <br /> /�� P <br /> a <br /> Ix <br /> w <br /> 2. NON HAZARDOUS WASTE LIQUID `e DM w� G <br /> 3. y <br /> 4. <br /> 13. Special Handling Instructions and Additional Information <br /> 9B1)SOIL 008082808 ayXs1- WEAR APPROPRIATE PPE INV#47671 <br /> 9B2)WATER#08082807lw5,j._ <br /> BILL TO:EXCELL <br /> 14.GIENi CERTIFICATION:I cedity the materials described above on this manifest are not subject to federal regulatlons for reporlinqAgill of Hazardous Waste. <br /> GeneratoesrOfe es PdntedrFyped Name Signature Month Day Year <br /> _ / G.0 I oL7 91 8 <br /> 15.Internsumnal Shipments ❑Import to U.S. ❑ <br /> po Fort from U.S. Port of entry/exit <br /> Transporter Signature for exports only): Date leavin U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Pdntedrryped Name �� Signature Month Day Year <br /> O <br /> a <br /> N <br /> Transporter 2 Printed?ypetl Name Signature Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity, E]Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number <br /> T 17b.Alternate Facility(or Generator) AS.EPA IDN arrlber <br /> 5 r�r-r�rns rr,tf; <br /> FII TrR <br /> LL Facility's Phone: <br /> w 17c.Signature of Ahemate Facility(or Generator) ` , , _ .• :-✓ Month Day Year <br /> z <br /> f7 <br /> w <br /> W <br /> r] <br /> 18.Designated Facility Owner o Operator:Certification of ceipt of materials covered by the manifest except as noted in Item 17a <br /> PrintedRyped Name Signature nfir Day spYew <br /> O <br /> 169-BLC-0 5 11977(ReJ.8/06) DESIGNATED FACILITY TO GENERATOR <br />