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0044S- 11 S4 <br />Fan Approved. OMB No. 2050-0039 <br />urease <br />prim or type. (roan oesngneo <br />lar use un era ki,nnmli'7i,t-1— <br />1. Generator ID Numbar <br />2. Page 1 d <br />3. Emergency Response Phone <br />b <br />A Manliest TnUenp NumMr <br />UNIFORM HAZARDOUS <br />CARO00149898 <br />1 <br />(866) 6117191 <br />000781215 JJ K <br />WASTE MANIFEST <br />5. Generaats Napm any Mayingfddmss Generam's Site Address (if different than mining address, <br />ea91e beg [.�rPorauan <br />7001rdependence lax <br />Oaklaed, CA 94621 <br />Geienehfs Phone: (866) 639-7191 <br />U.S. EPA ID Number <br />S. Transporter 1 Company Name <br />CAD982434037 <br />Brinell FitvFonmentel Corp. <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />Filter Recycling Services CAD98244+11%1 <br />8. Designated Fadliy Name and Site Address U.S. EPAID Number <br />CAD082409D19 <br />Crosby and Ov~ <br />M /r, <br />1630 West 17th Street cACD ooZc6L1zq (7k -I <br />Lora Beads, CA 90813 <br />Facisys Phone: <br />ga. <br />90. U.S. DOT Description including Proper Shipping Nam. Heald Class. ID Number, <br />10. Containers <br />11. Tote) <br />12. Unit <br />13. Waste Cabs <br />No. <br />Type <br />HM <br />and Paddng Gmup(dany)) <br />Quantity <br />WINol. <br />cc <br />1. <br />Waco Printing Ir4 Related Materials, 3, UN 3210, PG11 <br />DM <br />"C) <br />G <br />D001 <br />212 <br />214 <br />IW <br />z <br />W <br />Wec4 Solids CContainingFlammable Liryaids, 4.1, UN3175, PGII <br />OM <br />rT C <br />P <br />DOO1 <br />352 <br />I <br />3. 0A RMA hAZpPeaous w So 'o ;nc ;� <br />4 <br />P <br />36 <br />14: Special Handing Instruction and Additional Information <br />-t Weer approprieee protective equprinsi <br />.1)66907 <br />2)669D4 (;e♦K i161IS rVL"%nei) <br />w4scows <br />15. ENERATOR'SIOFFFROR'S CERTIFICATION: I here y delve hal he am this consignment are fuly any accurately described above by the proper shipping name, and an dassifted, pedhged, <br />marked and bbaledrpacaNed, and are in a8 respects In proper mmditnn for transport aaading to applicable international and national govemmental regulation. I export shlpment any I am the Primary <br />Exporter, I cavity Tat the mmenb of We consignment mnbnn to he tens of the attached EPAAdmowbdgrnent of Consent <br />I certify that he waste minimization statement Identified in 40 CFR 282.27(a) ('d I sm a large quantly generan,r) or (b) (ff l em a small quantity generator) Is he. <br />GenrebrsOBemes PdntedRyped Nam Signature Many Day Yeer <br />♦ <br />t 114107 <br />Fz❑ImpnMh <br />16. hbmetio SMpmena <br />U.S. ExpU.S. Pam olenglexit <br />❑M ham <br />— <br />Transports signature (for experts only): Can, leaving U.S.: <br />a' <br />17. ThnspalaMlmwMedgment of Receipt of Materials <br />Tranporbr 1 PonteN Name s Signature Month Day Year <br />8I <br />it 114 <br />Z <br />Tran r Signa Monro Day Year <br />cz <br />4 0'7 <br />18. 'somparwy <br />j <br />18a. Oisoepanq•I/Miatlon Space <br />Overrun,❑ Type El RL Partial Rejection on Relief. <br />�f t 1�� <br />*'7' <br />\� o Mambo Referents Number <br />1So. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />V <br />W <br />Fadlitys Phone: <br />W <br />1St. Signature ofAlhmale Fariiy(or Generate) <br />Monk Day Year <br />Q <br />2 <br />N19. <br />Haaardaus Vhsh Repan Management Method Codes (I.s., codes for hazardous waste aeaanent. Boposal, and recycling system) <br />p <br />t. <br />2. 3. <br />4. <br />2TOlisigrAi�naiad Fadley goner or Operator Centficallof0fraceprit of hazardous materials covered by the manifest except as nave in Item 18a <br />Ill <br />Pon aSignture � Marvinpay Year <br />EPA nn 00-22(Rev. renous editions are obsolete. ESI NA DFACILITY TO DES ATION STATE (IF REQUIRED) <br />10233.0370 ..... <br />