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NOU,JAZARDOUS WASTE MANU—T <br /> Please print or type (Form designed for use an elite(12 pitcuh)typewriter) <br /> NON-HAZARDOUS 14h ??,S4�o Manifest I'f'179fs 2.Page i <br /> (� y�WASTE MANIFEST Document No. of <br /> r+81011HF M�lNName and Mailing Add.. <br /> zh�ii 5 lvrt>'orl Wav <br /> Slnckfnn;CA 95206,CA 95206 <br /> 4.Generators Phone( ) <br /> 1Y1t��er=a1'BeH1b Y�la�ifdhE.�i('✓ft�}fi.l`_9'l� 6. US EPA UII r ,W10-11(.15*3 A.State Transporters ID •-S(litl <br /> 6.Transporter 1 Phone <br /> T.Transporter 2 Company Name 8. US EPA ID Number C.State Transporters 10 <br /> D.Transporter 2 Phone <br /> ri"�:klBsigel6�dFhoNllyYAan3�FidSu laidddss)tY_:.=WdI 10. US EPA ID Number E.State Facility's ID 1 AI,01.41, , ,)< .4 <br /> -y65Rlgg()F A+� <br /> Mmoel CA 05'3A i <br /> F.Facility's Phone <br /> 11.WASTE DESCRIPTION Containers13. 14. <br /> Toa Unit <br /> - [' t r 4 '] T ... No. Type Ouantlty WLN01 <br /> a. <br /> -1 c>wA (_) (J f0 <br /> G b r <br /> E <br /> N <br /> E <br /> R ` <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> Q PrDjeci Numbnu 16115 <br /> i)ERG#;109E7UCAI=AA-,�'�as r?c? <br /> U1 <br /> o <br /> 15.Special Handling Instiuctions and Additional Information <br /> Q <br /> N <br /> Q <br /> Z <br /> O <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify,that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. _ <br /> Data <br /> Printedrryped NameSignature Month Day Year <br /> ! � <br /> fr <br /> T 17. Transported Acknowledgement of Receipt of Materials Data <br /> R <br /> A P rj�,,,Jffyjaeidl N me ! • Signature r j Monts Day Year <br /> IN <br /> O 18. Transporter 2 Acknowledgement.1 11 of Materials 1 � ,� Data <br /> R <br /> T Printed/Typed Name Signature Marts Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> L20.Facility Owner or Operator:Certification of receipt of the waste materials covered by this manifest,except as noted In item 19. <br /> I Data <br /> T Printedirryped Name Signature Month Day Year <br /> Y <br /> OF14 02002 LABEANASTERO (800)621-5808 www.labelmaster.com <br />