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NON -HAZARDOUS 1 eenerate3 V$ IPA ID No <br />WASTE MANIFEST <br />4- Generator's Name and Mailing Addreaa <br />I;njfjCd Cjt'0eer5. <br />1`x`70 Picce!i R�..ad <br />Sroc�,n. CA 95215 <br />Generator's Phone <br />S. Transportar Company Name 8• <br />Ac(;n Vnvirenrnerltal Servir-�s <br />8. Denignated Facility Name and Site Address <br />Icon Enviromnental Services INC <br />1220 Whipple Road <br />Union City, CA 94587 <br />G <br />E 11, Waste Shipping Name and Description <br />N <br />E <br />R a. <br />T Nan -Hazardous waste, liquid <br />. b. <br />1 15. Special Handling instructions end Additional Information <br />B. <br />2. Page 1 3. Document Number <br />of N? 10273 <br />1 <br />RECEIVE <br />JUL 2 8 2014 <br />US EPA ID Number T-Transpo iONMENTAL HEAL <br />CAL 00(31362 9SO DEPARTMENT <br />US EPA ID Number 10. Facility's Phone <br />CAL CM 369 026 <br />12, COntalnery 13. 14. <br />Total Unit <br />No, pe uenti!y WWc <br />Handling Codes for Wastes Listed Above <br />11a. I 11 b. <br />F <br />A <br />C <br />I <br />L <br />I <br />T <br />Y 19. Facility owner or Operator: Certlncallon of <br />P&*dinyped Nam* <br />of waste materials Covered by this manifest except as noted in Item 18. <br />Signature <br />Month Day Year <br />WHITE —ORIGINAL (Return to Generator) YELLOW --TSDF (Retain Copy) PINK TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />Clean Tech Envircinmertt3i <br />!:..57�+►C� �rr...• ^:^�,.� L- �./�r� �� 4. i!_.\�, <br />�1'� {+. �...�ti..:(,, L�Ci�:-r,�'�. C:��-t "t•: �^_ r: n <br />=Xc: `,._r!� P:�.�� G,'..-i.'�- :� <br />�Q�.>..�. <br />1 s. 0ENERATOW& CERTIFICATION: I cellity tho materials descdbod abova on this manifaet ara not subject to sWte or fedetal regufationo for (®porting proper disposal of Hazardous Waste. <br />T <br />PrfntednWed IVetn� �. <br />r. . , i <br />Signature f <br />,A401th <br />Day Your <br />A <br />N <br />S <br />17'Transporter AcIvrOWladgement of Receipt of Materials <br />P <br />0 <br />Prirdedr yped Name <br />Signature <br />r <br />Man J(h Day Yegr <br />IS. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />I <br />T <br />Y 19. Facility owner or Operator: Certlncallon of <br />P&*dinyped Nam* <br />of waste materials Covered by this manifest except as noted in Item 18. <br />Signature <br />Month Day Year <br />WHITE —ORIGINAL (Return to Generator) YELLOW --TSDF (Retain Copy) PINK TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />