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Pleasa P' t or type.(Form designed for use on elle(12-pitch)typewriteci Form Approved,OMB No.2050-0039 <br /> (INIFRM HAZARDOUS 1."man ta"D Number 2.Page f of 3.Emergency Response Phone 4.Man'dest TNumber <br /> WASTE MANIFEST .p 0002-8929 FLE <br /> 161 5.Genetalor's Name antl,lAailN m 1 rens(ItliRerent than mailing address) <br /> Attn-Jamie Reines <br /> JA-.3. YRC FreWha ORF Reddawag <br /> 913-3A4 S2ii5 IoWj7 Fbe, Ave 3331 I Do�ie Rd <br /> Generator's Phos' <br /> .Transporter 1 ompany Name r <br /> U. . P0.1D um <br /> 7.T=F°rter2 n <br /> Lr�t�� c� Tws Q �,cooa a 17S 13 <br /> e.Designated acni Name and Site Address U.S.EPA 10 Number <br /> '� m Filter P.ecYcliuy SerTieee, ?nc <br /> 169 W. Monte Avpruie <br /> Rialte. nA 92316 <br /> r14403 <br /> Fadli s Phone: . - - <br /> 9b.U S.DOT Descrill(including Proper Shipping Name,Hazard Class,10 Number, 3pe <br /> 11.Total 12.Unit 13.Waste Codes <br /> 9a. QuaintlyWINoI. <br /> HM and Packing Group it any)) <br /> Ix 'Ron Rag ha:aardone waste. solid 16.1 <br /> 3. h <br /> 4. <br /> 14.Special Handling Instructions and AdQitional Intamagon 1 1 ;fU�1.; �, �h /,/N / M�• J_,+ <br /> One or more of the material Ilsted on tMs maNfaat may <br /> PROJt 523-7)�1731oi be recycled as alternative dally cover(ADC),or aver <br /> Fd1I Job #33822 method which uses the material In corp g+e75 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that 8a contents of this consignment are fully and accurately described above by the proper shipping name,and are Uassaft,packaged. <br /> marked and labeledfplaceded,and are in all respects in proper condition for transport summing to applicable irimmagonal and national governmental regulations,If expos shipment and I am the Primary <br /> Exporter,I tartly that da c Wft of this mnegr mart conform to his arms of he aaadad EPAAcknoWiedgment of Consent. <br /> I certify that the waste minimbation statement vera fled in 40 CFR 262.27(x)it I am a large quantity generator)or(b)(l I am a sr)all quantay generator)is true. ay aro, <br /> eneralN s noted yped Name rime q <br /> i8.'Intl Shipments ❑Importto U.S. ❑Export from U.S. Pat of shmnexit: <br /> Tra signature hr sin only); Dateleavin U.S.: <br /> w 17.TransponerAcknowledgmenl of Receipt of Materials ay ear <br /> Transporter 7 Prin ORyped Napw <br /> 6 <br /> z Transporter 2 POnted/TNa . <br /> t18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Ouanbry, ❑Type ❑Residue ❑Pamal Rejection ❑Full Rejection <br /> Mammal Relerente Number: <br /> U.S.EPA ID Number <br /> 186.Alternate Faaiity(a Generator) FILTER RECYCLING SERVICES' R! I-Tn F-ACII_ITY. EPE <br /> v <br /> LL Fadli 's Phone: A - -� (� Day Veer <br /> w 1&.Sl9natureofAllanateFaUliy(orGenemmr) AND WILL ACCEPT THIS WASTE AS SHIPPED. <br /> 6 <br /> 2 <br /> 19,HauNas Waste Report Management Method Codas(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1 ``� 2 3, 4. <br /> C t <br /> 20.Designated Facil4yVwner a Ope :Certification of receipt of hazardous materials covered by the man xcept as nosed i neem 18a nth Day <br /> Pnrkedfiyped Na S <br /> Ck <br /> EPA Form 8700-22(Rev.305)Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />