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NON-HAZARDOUS WASTE MANII-Jiil <br /> Please Drint or type `�' (Form designed for use on elite(12 pitch)typewriter} rj} 2.Page 1 <br /> Manifest <br /> NONHAZARDOUS F <br /> rator's US EPA ID No. Document No. j ( ofWASTE MANIFEST ' 982 508 251- l3.Generator's Name and Mailing Address Pat a�.llllermetyUr.ified Westerr Grs - Attr <br /> 5200 Sheila Street, Com-nerce, CA.. 90040 <br /> 4.Generators Phone( 32� 264-5204 <br /> 5.Transposer 1 Company Name 6. US EPA Ip Number A.State Transporters 10 — <br /> Fiatt Trac S, c. CAT 080 01 2 800 B.Transposer 1 Phone <br /> g, US EPA ID Number - C.State Transparter'slD <br /> 7.Transporter 2 Company Name D.Transporter 2 Phone <br /> 10. US EPA ID Number E.State Facility's 10 <br /> 3,Designated Facility Name and Site Address. <br /> ,,"Rerredy Ervirorrrer.tal <br /> p o..�+ L. FYor.tera STreet ' F.Facilites Phone <br /> Anaheim, CA. 92806 CAL 000 200 500 323-268-5056 <br /> 12. Containers .13. 14. <br /> 11. DESCRIPTION Total <br /> WASTE Q Unit <br /> .. Ni Type Quantity �U W1Nol.' <br /> a. <br /> T T G <br /> NONHAZARDOUS WASTE LIQUIDS <br /> G b. <br /> NY i�iLNTwt +' 70 <br /> R o at iii IM Mrwittt� <br /> R <br /> A <br /> T Fo+�l Uig <br /> Od. Decume"or <br /> CH.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> a. } tor.--hazardous water <br /> I <br /> PROFILE, #04- -01-069 <br /> l t P rT-6 <br /> i <br /> i � �15.Special Handling fnstruclions'and Additional Information <br /> Job Site: •Stocktor. Facility <br /> 199b Piccoli Rd. <br /> ;. GLOVES & GOGGLES 5tocktor. , J 95215 <br /> Em 4909-889-5607 <br /> r <br />�l 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents o1 this shipment are fully and accurately described and are in all respects - - <br /> in proper condition for transport.The mdescribed on this manifest are not subject to federal hazardous waste regulations. <br /> ml <br /> Date <br /> Signature Month Day Year <br /> rimed/ypeof N e/r <br /> I Jim. <br /> Date <br /> T17.Transporter 1 Acknowledgement of Receipt of Materials <br /> Signature Month rDay Year <br /> A Printad7Typed Name I b <br /> " /J� i 1 44 <br /> c <br /> S <br /> /"11'f Dale <br /> P - <br /> f aterials . <br /> tto <br /> rnent o <br /> t Reca .. <br /> 18.Transpaser2 AcknowledgeP <br /> OYear <br /> R Signature Month Day <br /> T PrintedlTyped Name <br /> E <br /> R <br /> 19.Discrepancy indication Space <br /> I F <br /> A <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L Dale <br /> ' yped Name / g re �,ronOth Da Year <br /> ':.� T <br />