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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- f.Generator ID NumbeC 2.Page 1 of 3:,Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST, -. „ CAT08OD11240 1 909-721-20W 0 0 0 4 5 91 G 9 JJ K <br /> 5.Generator's Name and Mailing Address - Generator's Site Address(if different than mailing address) <br /> SFPP LP On�xe <br /> 1100 Towne 6 Country Roa2947 Nary o 2947 N n, 95206 ' <br /> Orange.CA 92668 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Fllter RecycNng Sefvices,Inc. CAO082444461 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Veolia Es Technical Solutions LLC <br /> 1704 W.First.Streel CAD008302903 <br /> Azusa.CA 91702 <br /> Facilitys Phone: 826-334-5117 <br /> 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.N01. <br /> O X 1' Waste flammable Solid.organic,n.o.s.(gasoline),4.1,L)N1325,PGII .- OM P DDOt D016 :352 <br /> 1 <br /> DO <br /> X 2' Hazardous Waste Solid,n.o.S. (lead)9,UN3077,PGIII / DM fc -x P 4' D008 2 <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> 9b1)Contaminated absorbem wlgasohne Proflle#521188 Wear Appropriate PPE Invoice(+28663 <br /> 91b2)Soil w lead Proffie H h C-7 3$ <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certly that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(ff I am a large quantity,generator)or(b)(if I am a small quantity generator)is two. <br /> Ge a tors/Dfferor's Printedlryped Name Signatgre Month Day Year <br /> 16.International Shipments <br /> l ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> � Tra/gsport/er i Printedrryped Name,rte ,r ` ,ry\. Signature - -"`�/ Moth �°D},ayy fY�eaarr� <br /> 06 <br /> Z Transporter 2 Prinledrryped Name Signature Month Day Year <br /> C <br /> I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Partial Re j <br /> Residue Rejection El Ful Re edion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> zi <br /> U <br /> LL Fa6liys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hamrdo ' aste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1. Cry r/ 2. 3. 4. <br /> i20 Desgnatri'd Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted to Item 18a <br /> PnntedRyped4Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. 'J C-i DESIGNATED FACILITY TO GENERATOR <br /> (r' <br /> VV <br />