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WHrrE —ORIGINAL (Retutn to Generator) YELLOW —TSDF (Retain Copy) PINK—TRANSPOnTER COPY OOLVENROD —GENERATOR'S COPY <br />LTB <br />NON -HAZARDOUS <br />1. Generaloes US EPA ID No. <br />2. Page 1 <br />3. Document Number <br />WASTE MANIFEST <br />of <br />N° 10-377 <br />a. Generator's Name and Mailing Address <br />R V E <br />Un!Fk-d >v mace, °',`i <br />1q90 Piech Road <br />Stecktnn. CA 9521.5 <br />JUL 2 8 2014 <br />Generator's Phone <br />S. Transporter Company Name 8. US EPA ID Number <br />u <br />7, Transporter Phawa` `IRON oM EN TAL n <br />�IV V EA <br />icon Erlvirrnnmertifi Service.-, CAL JOC 362 9W <br />DEPARTMENT <br />B. Designated Facility Name and Slip Address 9. US EPA ID Number <br />10. Fnclllty'a Phone <br />sten iFrTvirortmentall Servicec Inc <br />510-475- 1740 <br />".220 Whiuple Rciad CAL GOO 369 625 <br />I niop City,CA 94587 <br />G <br />E <br />N <br />11, Waeta Shipping Name and Description <br />1Z. Containers <br />13. <br />14. <br />E <br />No. <br />Total <br />Quagjib <br />Unit <br />Ra <br />T <br />Non -Hazardous waste, liquid GJ <br />0 <br />61_� <br />R <br />b, <br />15. Special Handling tnetructiona and Additional Information <br />-Handling Codes for Wastes Usled Above <br />11 a. I l b. <br />Y. <br />CIPar1 T, -,Ch F.;rav;rcantnw}3,�i <br />16. GENERATOR'S CERTtF'ICATtoN: Icerilly the materials described above on this manifest are not subiect iwflatl or f e I regulations for reporting proper disposal of Hazardous Waste. <br />Prtnted> Typed -Name /` <br />Signature i <br />Rj <br />/ /� <br />J <br />Month Day ye&r <br />A <br />N <br />S <br />17. Transporter Acknowledgement of Recalpt of Materials <br />0 <br />O <br />Printed+Typed Name <br />Signature <br />Da Y <br />18. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />1 <br />T <br />Y <br />19. Facillity Owner or Operator. Cartlfication of receipt of waste materials covered by this manlleat oxclet as noted In Item 18. <br />Printed/Typed Name <br />Signature - <br />l <br />Monfn Day Year <br />WHrrE —ORIGINAL (Retutn to Generator) YELLOW —TSDF (Retain Copy) PINK—TRANSPOnTER COPY OOLVENROD —GENERATOR'S COPY <br />LTB <br />