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�1 . '"S 5'1 i 4rA <br /> &7 2 sxtctr typewriter r rY r —A <br /> NON-HAZARDOUS 1 Generators US EPA ID No7b�+am%nto3 2 of g 11 <br /> WASTE MANIFEST <br /> Ss.l$tpyra8Mttgie and Mailing Address <br /> ,,_ P o BOX 903 <br /> r ECRREGO SPRINGS, CA 92004 <br /> # 4 Generator's Phone( 888 ) 701-6600 <br /> ransporter 1 Com cgny Name 6 US EPA ID Number A Transporter's Phone ���)873-4 1tF 1 <br />� Ctter Recyclrlg Services, Inc. C A D 9 8 2 4 4 4 4 8 1 t <br /> 7 Transporter 2 Company Mame B US EPA 1D Number B Tronsporter's Phone <br /> c + <br /> rY+ y 9 Designated Facility Nome and Site Address 10 US EPA iD Number C Facility's Phone <br /> Filter Recycling Services, Inc. ( 909)421-2011 <br /> 180 W. Monte Avenue <br /> Rialto, CA 92316 C A D 9 8 2 4 4 4 4 8 1 <br /> I <br /> I l Waste Shipping Nome and Description 12 Containers 13 14 <br /> Total Unit <br /> f No Type Quantity Wt Vol <br /> Mn-Razardo <br /> ,i a <br /> it D L <br /> t <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> ZbodncS4D4sjnphons for Materials Listj�FQFr+1,E iff E Handling Codes for Wastes Listed Above <br /> I k H <br /> 4 e e Pj)1" lop iVgO,ln(�+vl;%ng AGE/Advanced Geo office <br /> 24 Hour Emergency Response lit ( 909) 721-2038 837 Shaw Road <br /> Bill to: Slaby Sales Stockton, CA 95215 <br /> r <br /> 1 ' <br /> l <br /> 16 GENERATOR'S CERTIFICATION l certify the materials described above an this manifest are not subject to Federal regulations for reporting proper disposal of Hazardous Waste <br />' Printed/Typed Nome Si n Month Day Year <br /> 'TF—L V^ -A PY <br /> T 17 Transporter 1 Acknowledgement of Receipt of Matenais 1 <br />' { S P nted/Typ�d NayseSign r Manl6 Y Year l <br /> i.C�- I <br /> P <br /> w a 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br />' 7 Panted/Typed Name Signature Manch Dar Year <br /> a E 1} <br /> + 19 Discrepancy Indication Space <br /> 1 F <br /> A i <br /> 20 Facility Owner or Operator Cettificar"n of receipt of waste materials covered by this manifest except as noted in Item 19 j <br /> t T A ? <br /> Y <br /> Day YeoroPnnted/Typ Sig re y <br /> Kr";a ss ins int ' ORIGINAL RETURN TO GENERATOR �� � 1 <br />' �§L'_ <br />