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Form Approved.OMB No,2050.0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS f gng-322-Q7'4 009216035 JJ K <br /> WASTE MANIFEST CAD`+'14599d4 <br /> than mailing address) <br /> 5.Generator's Name and Mailing Address Generators Sile Address(if diHerenl <br /> Blkr7 RAILV+l.4Y CID—..,.,.,.,.,. FTJA D,A,i;lUt,lp f Tr rFT <br /> 740 EAST CARNEGIE DRIVE ii{TCrAi,Gr. 9= Cio U.S.A <br /> Z4PdV EIERNAR011`40-CA 92416 U.-S.1'. <br /> Generators PhonW9-.fM-4r--11-'= U.S.EPA ID Number <br /> 6,Transporter 1 Company Name ECAIR0 rn172AFf-1 <br /> hd'JIRCtNFaIENTP,L UOGI�TIC=,IIUC <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Desiynaled Faciliiy Name and Site Address FILTEF. RECYCLING SERVICE3,IhJC ''""' <br /> 180"A EST MOPITE AVENL IE <br /> QLUn131v11NGTOPJ,CA 92316 U.O,A <br /> Facility's Phone:909-421-2901? <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Cortes <br /> 98. No. Type Quantity Wl.Nol. <br /> HM and Packing Group(If any)) I <br /> t. o, !`�'.; Cial T 611 <br /> � NUPI RCR. I-x.�FQC11_IS'J+(P.STE SOLID - <br /> O t�0 <br /> g <br /> LU <br /> I t <br /> —3. <br /> 4. <br /> I <br /> I I <br /> 14.Special Handling Instructions and Additional Information 11,1 fn� <br /> Dal) SuiL,BALLAST(ROCHj,LE.A.D 8.3 STLC,TRPH --300 PPI-11 PROFILE#. vL.r�- _ IhPJ01GE412z91�' <br /> F'LE,�._'E 'J+IEPR :�.F'PROF'F'!?,TE F'F:OTECTIVE EQ IIPFAE14T. �ceX A O c E <br /> 15. GENERATOR'SfOFFEROR'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 labeledlplacarded,and are In all respects in proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primar/ <br /> Exporter,I certify that the contents of this consignment conform to the terms of the allached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)Is true. Month Day Year <br /> Generatoes(Offeror's Printed/Typed Name . Signature <br /> sof' �� ' <br /> h16 International Shipents �,mImport to U.S. ❑Export from U.S. Port of enlrylexiL _ — <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Marlir Gay Year <br /> Li Signature Transporter l Printed(lyped Name <br /> a , t x,1 G �' Month Day Year <br /> ZTransporter 2 Prinledffype Name S' ure <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space Quant ❑Residue Partial Rejection❑ ❑Full Rejection <br /> Quantity Type <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 16b.Alternate Facility(or Generator) <br /> J <br /> U <br /> Facility's Phone: Month Day Year <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Uj 3, 4 <br /> 1 . <br /> 20.Designated Facility Owner or Opera or.Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a --- <br /> Month Day Year <br /> PrintedrTyped Name Signature —� `50 r <br /> v <br /> l <br /> EPA Form 0700-22(Rev.3-05) Previ us editions are obsolete. k=,l,C1�.1 1'!TO E"JEt3 T IP9,Ai I�i\l 5'il'/-1`I E(16= FfECIi>JIt��C7 <br />