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NOh iAZARDOUS:WASTE MAN 1► _ T <br /> ,tP4eass pnnt'ar type u'(Foorm desiiggnedrfocr use <br /> +n elite(12 pitchy typewriter} - :Mandest - - .2.Page 1 <br /> NON-HAZARDOUS ' t:GenerafurstJSEPAIDNo DacumeniNo of lr <br /> 51 <br /> WASTE:MANIFEST:: (Mo 932 503 251 . .. 4' <br /> 3 Generato's Name and Mailing'Address <br /> -', <br /> - L71�ifi e>1. vies ergrs Attu. <br /> 520.0 Sheila <br /> 90040 <br /> 4.Gerierators,Phone.f 3-M ; 264-5200 <br /> 5.Transporter 1 Company Name - _ 6. US EPA 10 Number - A.State Transporter's ID <br /> F' �r3 �7 + IS.Transporter 1 Phone., �- <br /> E` t Ttans Dic' . <br /> 7..Transpprler 2:Gompany Name US EPA-IQ Number-- - - 'C.State Transpertees ID <br /> D-Transporter 2 Phone - <br /> ed Facility Name and Site wddress ' 10 U5 EPA IQ Number, - - - --E:State Facilitys ID, <br /> 9.Desi net ry - <br /> _�eCvIr . <br /> �1. <br /> F.Facility's Phone <br /> 3200 E.-.F ro'ntera-Street <br /> ,aha iein C�1. 928fl6 nor 2�J d� =� <br /> - 12 C�ntaners- 13 14: <br /> 11.'VVASTE'DESCRIPTION ' Total .: .. Unit <br /> No Type.,',. Quantity Wt.Nol. <br /> 765 <br /> a: <br /> TT G: <br /> b. <br /> N <br /> .JE <br /> A <br /> } <br /> G Addpional QescripHons 10r MateriaisCisted Above _ H'Handling Callas for Wasies Listed Above. <br /> - - - <br /> "oi:hazai&i5•seater <br /> PROS IF #04 HGfr-(1 3 9 d 11 <br /> r ]} <br /> 1^ 15,Special Handling Instructibns and:Additional.lnformation i_` <br /> --Job ,Sites- tQC 1031 r'1C.1•.1. <br /> 1:990icecill Rd. <br /> GIDS &= T.ES' StoGktony' CA. 52I 5 . <br /> MEAMM <br /> "78.GENERATOR'S CERTIFICATION:t herebycertity that the contents of ttiis shipment are fully and accurately`de§cdbed and are in all.respects,;.,..:.,In proper condiligq for transport.The materials described on this--manifest are.not sublectdo federal haZaidcus waste-regulation$ <br /> Date .. <br /> PnntedlTyped Name Sl 7Norilh' .Aay Y <br /> T' X17.Transporter t Acknowledgeii en!of Receipt of Materials Date. :. <br /> "R Signature. 141 w Mo f Day''-'Ye_ <br /> A Printyd7 <br /> Narne <br /> N' <br /> S <br /> . Date <br /> -- tf4 Transpone;:2;Acknnwladgement of Receipt Ot Materials - <br /> T '::Y6rilecirryped Name'. Signature Month°.' -Day Year <br /> R <br /> 19.Discrepancy Indication'SPapa:. - <br /> 'F <br /> q <br /> .20.'Fac0iry Owner or Operator;Certification of receiptol the-waste materials covered by this manifest except as noted m item 19 - -- <br /> L <br /> nature - - Monfh';.` Day;; .-Year <br /> ,�' Printeil%fyped Name -_ ,, " g _ _- <br /> Y. <br /> F.1402002 - .i..MEL.MASTER®(800)627�5808 www.laDetmaster.com��', mPnMlebONRECrctERviwt:d�.�,,,.ro r - .`.Rev <br />