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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 prtch)typewriter) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. ManDocifest <br /> tnt No. 2-Page 1 <br /> WASTE MANIFEST cryrn)�7 89 of <br /> 3.Generators Name and Mailing Address E—M* 94(Z11 <br /> ?s IE A L 111 iv E' AVE CRRDNb EIZ, <br /> 4.Generator's Phone( ) 5UMN,N <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> CA O elt! I B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility s ID <br /> INSTRAT,INC. <br /> 1105 C AIRPORT RD. F.Facility's Phone <br /> RIO VISTA.CA 94571 (W)37444014 <br /> 11.WASTE DESCRIPTION 12. Conta Hers 1 t 14. <br /> Total Unit <br /> No. Type Quantity Wt./Vol. <br /> a. <br /> PuQ6E wmsy� I �°Ly ?55 vJJ <br /> G b. <br /> E <br /> N <br /> E <br /> R c- <br /> A <br /> T <br /> O <br /> W <br /> R d <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> U) SROwN� FI/VE5/ No o-POR <br /> 0 <br /> a <br /> N <br /> 15.Special Handling Instructions and Additional Information <br /> Z <br /> 0 <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 /> Date <br /> Printed/Typed Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> P s c.o+� e c 42 . 13 13 <br /> E) 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <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 Date <br /> T Printedfryped Name Signature n Month Day Year <br /> Y MIC-HAEL W 'A 12- 13 1 13 <br /> F-14 0 2002 LABELMAS O (800)621-5808 www.labelmaster.com Rev.3/95 <br />