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NON—HAZARDOUS <br />WASTE MANIFEST <br />4. 0enerator'a Nem And Mailing Address <br />T. Generator -. US EPR ID No. <br />LIn1fret G'rccef s <br />�O40ir!)ICC7�i igaat� <br />Stockton, A 95225 <br />Generator's Phone <br />S. Transporter Company Name 8. US EPA ID Number <br />!Can Ery rcrrl rely*ai Sin,+ices CAL 000 352 -980 <br />S. Designated Facility Name and Site Addresa g. US EPA ID Number <br />Icon Enuirorls~IQnta•. Se�r;c�; Inr. <br />1-220'U hiipple Read <br />U?Iir,rC;ty, CA 94557 <br />G <br />E 11. Waste Shfpping Name and Description <br />N <br />E <br />R a. <br />T Non -Hazardous Waste, liquid <br />O <br />R is <br />I i 15. Special HandlIN Instructions and Additional Information <br />CEean Tec's. Environrrte»tai <br />CAE 0100 369 0216 <br />2- Page 1 3. Documenl Number <br />of 1 N? 10540 <br />RECEIVEL_��- <br />7. <br />Transporter phone US 2014 <br />NVIRQNM <br />10. Faciifty'a Phone DEPARTMENT <br />510-476-1740 , <br />12. C2Snlalnera 13. 14, <br />dTotal Unit <br />wm <br />Handling Codes for <br />118. <br />18. GENERATOR'$ CERTIFICATION: I certify the materials described above on this manifest are not subieM to stats or federal n <br />A <br />Prinledtlypad Name <br />Kim <br />Signature <br />r� <br />N <br />17. Transporter Acknowle ment of Receipt of Materials <br />P <br />O <br />Prinied/Typed Name <br />Signature <br />In.y.. <br />1 I Dfscroparlcy Indl6lion Space ' <br />F <br />A <br />C <br />I <br />L <br />T <br />Y 19. FAcflity Owner or Operator: Certillcaflon of receipt of waetg materials covered by this manifest except as noted in item ta. <br />Printed/Typed Namg I Signature <br />Listed Above <br />111b. <br />for reporting proper disposal of Hazardous Waste, <br />Month Day Year <br />ar Month Day Year <br />Month Day year <br />WHITE —ORIGINAL (Return to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD --GENERATOR'S COPY <br />