Laserfiche WebLink
NON -HAZARDOUS WASTE MANIFEST <br />Please print or type (Form designed for use on elite (12 pitch) lypewnter) <br />NON -HAZARDOUS Fenerator's US EPA ID No. Manifest 2. Page 1 <br />WASTE MANIFEST 0,-) 2- 2.S (of 1 <br />3. s A3 -1"N,. E GS ADM NiSTRATOR <br />2855111!. 190TH ST. #110o s e d r 6f G /{ �i<o c fE til <br />TORRANCE, CA 90504 <br />4. Generators Phone ) p r <br />( 810 212-2938 e) [C'4� �{ <br />5. Transporter 1 Comp Nine D �� 6. US EPA ID Number A. State Transporters ID 707- <br />CjK) B. Transporter 1 Phone <br />7. Transporter 2 Company Name 6. US EPA ID Number C. State Transporters ID <br />9 Designated Facility Name and Site Address 10. US EPA ID Number <br />NSTAAT NCS <br />1105 C. AIRPORT ROAD <br />RIO VISTA, CA 94571 <br />11. WASTE DESCRIPTION <br />a. <br />3NON-HAZARDOUS PURR VIATER <br />G b. <br />E <br />N <br />E <br />R <br />A <br />T <br />O <br />W <br />R d. <br />H <br />QG. Additional Descriptions for Materials Listed Above <br />cn <br />O <br />c <br />a <br />Q15. Special Handling Instructions and Additional Information <br />Z <br />O <br />Z <br />D.Transporter 2 Phone <br />E. State Facility s ID <br />F. Facility's Phone <br />530•'753-1829 <br />12. Containers 13. 14. <br />Total Unit <br />No. I Type Quantity Wt./Vol. <br />tI�yJ_f4V, e <br />H. Handling Codes for Wastes Listed Above <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 />Printed/Typed Name //. Sfg�� <br />T 17. Transporter 1 Acknowledgement of Receipt of Materials <br />RSigna <br />NPrinted/Typed Nam ^� rt F� <br />S V J <br />P 18. Transporter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed Name Signature <br />E <br />F3 <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 20. Facility Owner or Operator; Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br />L <br />T Printed/Typed Name Signature /t <br />Y M t t 1� 142 l J y i rE+1 F.—i� �,.J' 1 <br />F-11402002 LARELMASM ® (800) 621-5808 www.labelmaster.com AM miwrn nn RFr.VrJ Fn PAPFR rO.T <br />Date <br />Month Dalea <br />�% << G <br />Date <br />Month D Year <br />DZ iz l5 <br />Date <br />Month Day Year <br />Date <br />Month Da Year <br />2IZ�Iis- <br />Rev. 3/95 <br />