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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) _ _ Form Approved.OMB No.2050-0039
<br /> UMI oPM HAZARDouF 1,Generator ID Number 2.Page 1 of 3.Emeryency Response Phone 4.Manifest TTrraacking Number p p WASTE MANIFES i _ (;rtG9 i 6590!.1 � ,2-G72-1 l_1 �216033 NJNJ Ifs
<br /> 5.Generaloi's Name and Mailing Address Generator's Site Address(if different than mailing address)
<br /> FlNSF RAILWAY Crl.,.,.,.,.,•,•,- 6111 1—A;>ngr,psr •ISTRI E?
<br /> 740 EAST CARNEGIE DRNE
<br /> P,AJdBERf�ARDINO.CA a_^^-1108 U.S.r�. STCrc7f:ILrOf,Cr1 '_:6266:1 (f,:�,t..
<br /> Generator's Phoneh 2,:,'W-40G,
<br /> 6.Transpoder 1 Company Name U.S.EPA ID Number
<br /> EN'JIPONNIENTAL I r GISTICS,IN I C S.RC0017?d50
<br /> 7.Transpoder 2 Company Name U.S.EPA ID Number
<br /> 8,Designated Facility Name and Site Address _ I U.S.EPA ID Number
<br /> FILTER .ECYGLIAIG SERVICES,IP1C �'{no .r e a,4
<br /> 180I'dEST h,9UNT[ AVENUE L 1 LW Y4 LVi
<br /> I3L00N1INGT0N,CA 92316
<br /> Facility's Phone 909-'1`1=012
<br /> 9a 9b.U.S DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit
<br /> 13.Waste Codes
<br /> HMI and Packing Group(if any)) No. Type Quantity I WLNoI.
<br /> 1- MON1 RCRA HAZARDOUS VVA TE SOLID � C m T 611
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<br /> I-
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<br /> 4.
<br /> 3 —
<br /> 14.Special Handling Instructions and Addil!onal Information
<br /> 331) =0ILI7ALI. AST(f;.0C ;),LEAD .3 TLC,TRPl`{ .:.300 P7=A PROFILE.-Ali 0�VOW- 1!'.jt•irDIGEr � S�-�%- /SI�Z'�` X20
<br /> PLEASE Ei AR*. AGPROPRlait PROTECTI'VEE EQUIP41IFNT.
<br /> 15. GENERATOR'SIOFFEROR'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 Iransport according to applicable International and national governmental regulations.If export shipment and I am the Primary
<br /> I Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknovdedgment of Consent.
<br /> I certify that the waste minimizalion statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(III am a smafl quantity generator)is true.
<br /> Generator's/Offeror's Printed/Typed Name f' - 1 alUry Month Day Year
<br /> -r 116.International Shipments ---
<br /> 1— U m Import to U.S. Export frorCS. Port of enlrylexll:_
<br /> Transporter signature(for exports only): Date leaving U.S.:
<br /> 17.TransporterAdmo,vledgment of Receipt of Materials
<br /> r Transporler 1 P,dnledf.Typed Name t Signature J� Month Day Year
<br /> j0.,,.•.,
<br /> Transporter 2 Printed/Typed Name mature Month I Day I Year
<br /> A 18.Discrepancy
<br /> 18a.Discrepancy Indication Space U ouanlity ❑Type
<br /> ❑Residue 1:1 Partial Rejection ❑Full Rejection
<br /> Manifest Reference Number:
<br /> 'l8b.Alternate Facility(or Generator) — _ U.S.EPA ID Number
<br /> Facility's Phone:
<br /> 1118r..Signature of Alternate Facility(or Generator) MonthDay Year
<br /> II—
<br /> !�-_1� —
<br /> Cvrj J 19.Hazardous Wasle Report Management Method Codes(i.e..codes for hazardous waste trealmenl,disposal,and recycling systems)
<br /> 4.
<br /> 20.Designated Facility Owner or Operalor Cerlificalion of receipt of hazardous materials covered by the manifest except as noted In Item 188 ^
<br /> Prinled/fypedlMame ' Signature � Month Day Year
<br /> EPA Form 8700-22(Rev.3-05) Prevfou adilions are obsolete. �::T�.�.y „•y r ,.•-r, C-.-,, , :,,; ;.Y 11�-;
<br /> ._,..;'rrl--:!�_.-..) 1-rel,.)�, 3_S _1L.J 1.1I....-r'i::r;'�1 .•1: .,,.1_ -..._.
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