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fr/ "k '� I <br /> Form Approved.OMB No.2050-0039 <br /> ' ri r use elite 1�2- itc ewriter. pp <br /> Please print or e. Form dell ed fo us <br /> P � ) <br /> a h� f '� ( _ <br /> UNIFORM HAZARDOUS 1. e ID Number- 2.Pag 7 of P.Emergency Response Phone 4.Manifest Tracking Number r <br /> WASTE'MANIFEST S Q 5 G B ' <br /> 5.Generators Name and Mailing'Address Generator1f Site Address(if different than mailing add�?Rgss) 1 <br /> Sado 6HIE71 `r �'omm�� CAfwga !9W PiCcc�u /2,D. Po.Owe bc)753 <br /> Generators Phone: �• f i <br /> 6.Transporter 1 Company Name .. U.S.EPA ID Number' <br /> San Joaquin f=ilter.Recyd ncr C L000102731 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number . <br /> 8.Designated Facil�Pt�jid�dQ U.S.EPA ID Number <br /> 14287:E.. Manning, Parker, CA. 93643 <br /> (.559)498-02 �'AL�"lC??1('2751 <br /> Facility's Phone: <br /> ga 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.Nol. <br /> 1, 1`4 ? Hazardous axle. <br /> T 'A ! ;l, �Ti <br /> T- -a n '' A —A f1i11. � <br /> � vx u,-x �i..:,�vu n.�sa. ..•�ia;v�u iu�xz3 _.'- .-.�,. Tr <br /> 2: - <br /> Ujw <br /> 3. <br /> 4. �... . I <br /> 14.Special Handlin Instructions and Additional Information <br /> w' <br /> We, Prot�ctitfe Cltat�2inb ,: �meriienc��?esponse t <br /> tnntact - Sari 3'naetuzn Filter Recycling <br /> GENERATOR'S10FFEROR'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 govemmental 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 EPAAcknowledgment of Consent. <br /> 1 certify that the waste mimmiz on statement identified in 40 CFR 262.27(a)(if I am a large quantity.generator)or(b)(if t am a small quantity g etator)is true. <br /> Generators) eror rintedirrypeA Napie Signature Month Day Year ; <br /> { <br /> a 16.In emalional Shipments <br /> 2 ❑Impost to U.S. ❑Export tram U.S. Port of ent ylezit: <br /> -- Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials _-...._. : . :._ - -. <br /> Transporter 1 Pdntedfiyped Name Sgnature Month Day „'.Year <br /> a ;^ <br /> Transporter PrintedfTyped Name ignatureMonth- Day' Year <br /> Q <br /> tr v <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue. ❑.Partial Rejection El Full ReIeciivn i <br /> Manifest Reference Number: <br /> 18b.AlternateFacility(or Generator) >U.S.EPA ID Number <br /> W Facility's Phone: <br /> Lo 18c.Signature of Alternate Facility-(ar Generator] Month' Day Year <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJI I, 2' 3-, 4. <br /> 14 141 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a <br /> PrintedffypedNameSignature Month .,Day Year <br /> 67 <br /> EPA Form 8700-22(Rev-3-05) Previous 6ditions are obsolete. <br /> 'S DESIGNATED FACILITY TO GENERATOR <br />