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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Farm designed for use on elite r:2 p(ch)typr-wwdrl <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> WASTE MANIFEST Document No. ( of <br /> 113 9 <br /> 3.Generator's Name and Mailing Address Flh* 9M�-�lC A <br /> CA+zoNo Ekl <br /> 75 F. ALPINE A� <br /> 4.Generators Phone( ) SM(4�-TMJr CA <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporters ID <br /> C49(Z'f.NO e7(,I B.Transporter i Phone <br /> 7 Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> )esignated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> F.Facility's Phone <br /> 11.WASTE DESCRIPTION 12- Containers 13. 14. <br /> Totat Unit <br /> t)' No. Type Quantity Wt.Nol. <br /> Tl a <br /> Pb1`1-Hif)z P SE l,� z ! -y 171 G�c <br /> G b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> QG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> O <br /> D <br /> Q <br /> Q15.Special Handling tnslruclions and Additional Information <br /> 1 <br /> Z <br /> O <br /> Z <br /> 16.GENERATOR'S CE"FWATION: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 /> Date <br /> Printed/Typed Name Signature Month Day Year <br /> TT 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> Printed[Typed Name Signature Month Day Year <br /> S 5co-ff' <br /> Q18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> .R <br /> 19.Discrepancy Indication Space ' <br /> F <br /> A <br /> C <br /> I 20.Facility Owner or Operator:Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L Date <br /> I <br /> T Printed/Typed Name Signature Month Day Year <br /> F-14@2002 LABELAASTERO (800)621-5808 www.labelmaster.com reixrton2 Rev.3195 <br />