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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WASTE MANIFEST CAR0002018M 1 800.424-Soa1 009503582 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) CHEB tXV PRODUCTS CO Cx 6004 AMI: K Nr��RRIS CHEVRON#307709,10858 TRINITY PARKWAY P.O.P.Ca. ESiSSTOCKTON,CA 95219 SAN RAWM,CA 945tss Generator's Phone: 877-3W-0044 4 6.Transporter 1 Company Name U.S.EPA ID Number ENVIIROt mf r�1^.I : ,- TICS, INC CAR000217513 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facili Name and Site Address U.S.EPA ID Number FILTER R9CYCLING SERVICES,INC. 180 WEST MONTE AVENUE CAD982444481 RIALTO,CA 92316 USA Facility's Phone: 800-698.4377 9a. 9b.U.S.DOl'Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No, Type Quantity Wt.Noi. 1 UN3175,SOLID CONTAINING FLAMMABLE LIQUID,M.O.S. 1 DM P 362 O (GASIDIESEL FUEL FILTERS),4,1,PG 11 t w a 2. i 3. �l 4. I 14.Special Handling Instructions and Additional Information 913.1)FILTERS&HOSES SCRAP METAL#08022129 Jl( WEAR APPROPRIATE PPE INV#150058-N EMERGENCY RESPONSE CHEMTREC 1-800.424-OW CCN868232 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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimizatioq statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quanp generator)is true. Generatgt s/Offeror's Printed yped Na a Signature 0130 Month tDay Year J-W .J 16.International ShIpMents rr-, zu Import to U.S. ❑Export from U.S. ort of entry/exit: _,__,___ ....... Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materi s Transporter 1 P inted/Typed Name Signature Month Day Year - AV774 QTransporter 2 Printed(Typed are Signature Month Day Year t- 18.Discrepancy 1 Ba.Discrepancy Indication Space El Quantity �nl LJ Type M-Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U U- Facility's Phone. N18c.Signature of Alternate Facility(or Generator) Month Day Year a Z 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1. 2. 3 11010 . 4. 20.Designated Facility Owner or Opprrrator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name � Ay� Signature ..l PMP Day Year - )_y a EPA Form 6700-22(Rev.3-05) PreUus editions are obsolete. DE SI ATD FACILITY TO DESTINATION STATE (IF REQUIRED)