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rTMMAZARDOUS or type,(Form designed for use on elite('12-pitch)typewriter.) Form Approved.OMB No.2050-0039 RH1.Generator ID Number 2 Page 7 of 3.Emergency Response Phone 4.Manifest Tracking Number !�¢' E ANIFEST A 0 9 '� � 4 3 5 3 5 1 1— $L'E3-�h�1-9.e`Jx0 018150097 J K rator's Name end MAIng Addreseling address) €trt�ns Cattrens DiO t01aintenarre Lodi hAS P.0 soy 2m - - 64S E.Pine at Stockton CA 952f11 Lcdl CF 9S2�k0 Generator's Phone: o g a 3 1 ° 3, 6.Transporter 1 Company Name U.S.EPA ID Number Environmental Logistics, lne. C A R Q 0 0 2 1 7 5 1 3 7.Transporter 2 Company Name U,&EPA ID Number 8,Designated Facility Name and Site Address U.S.EPA ID Number Filter recycling services,Inc. 180 W.Monte Avenue Bloomington CA 32816 Facility's Phone: 909 421.2¢12 CAD 9 8 2 4 4 4 4 8 1 as. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers I .Total 12.Unit HM and Packing Group(T any)) No, Type Quantity WINOI, 13,Waste Codes 0 1 Non-RCRA Hazardous Waste Liquid(Oily Waterl 2L3 Z 2. i 3. l 14.Special Handling Instructions and Additional Information 1 f(9Fj 4t1 Water-N16MI19 yt, 807P9:N 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,ad are classified,packaged, marked and labeled/placarded,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 Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached.EPAAcknowledgment of Consent. I cedity that the waste minimization statement identified in 40 CFR 262.27Ia)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true, Generator'/ emr'•s{P'1"i'ntedlTyped Name n ure Month JDayy+ Year J i6.lntematlot Shipments � ^ J z ❑Import to U.S. ❑Export from U.S, Pod of entry/exit: Transporter signature(for exports only): Date leaving U.S.: w 17.TmnsporterAcknowledgment of Receipt of Materials Traroportlia 1 Printed/Typed Name Sig etur Month Day Year ZTransporter 2 Printed/lyped Name Signature Month Day Year Na iscrepancyDiscrepancy Indication Space ❑ OuantAy ❑Type ❑Residue ❑Partial Rejecllon ❑Full Rejeclian mber:lternate Facility(or Generabr) US EPAIb Number y's Phone:ignature of Alternate Facility(or Generator) Month Day Year zardous Waste Report Management Method Codes(i,e.,codes for hazardous waste treatment,disposal,and recycling systems)2. 34.Lsignated Facility Owner or Operator:Coddcation of receipt of hazardous materials covered by the manifest except as noted In Item i ea/Typed Na e Signature Month /Day Yeatrs EPA Form 8100-22(Rev. 05) Previous editions are oheolete. L 6 o P3ESPCsF�/-':1°EPS f=AC{I_PTY 0EST1%1ATII� STATE (IF REQUIRED)