Laserfiche WebLink
—� NON -HAZARDOUS 1' Oevarator'v U5 EPA ID No. <br />WASTE MANIFEST <br />4_ Generator's Name and Mailing Addrea9 <br />Unified Graters, <br />1990 picc©!i R( -'ad <br />Srorti +sit. CA 95215 <br />Generator'a Phone <br />5, Transporter Clsmparty Name e• <br />Icon Envirent-neint:at SewlceS <br />8. Daaignated Facility Neme and She Address <br />Icon Environrr,enta! S4 r,Tvi;es rrt <br />1220104hippl- Road <br />Unions Ci'y, CA 94587 <br />G <br />11. Waste SNpping Name and Description <br />N <br />E <br />R a. <br />A <br />T Non -Hazardous waste, Ilquid <br />R b. <br />1 15. Special Handling instructlone and Additional Information <br />9. <br />_„_, <br />2. Page 1 3. Document Number <br />of 1 M 10273 <br />, <br />US EPA ID Number 7. Transporter Phone <br />CAL 000 362 980 <br />US EPA ID Number 10. Facility's Phone <br />5:1.0-476-'740 <br />CAt 000 369 026 <br />12. Conialnem 13. 14, <br />^Total` Un? <br />1AM111 <br />Handling Codes for Wastes tinted Above <br />11a. I 11 b. <br />P Printed/Typed Name Slgrlature <br />R� ' i <br />r Month Day YW <br />E 77 <br />IS. Discrepancy Indication Space IL ii. <br />F SEP 19 2014 <br />A <br />C ENVIRONMENTAL HEALTH <br />LME -PAR T WIENT <br />( <br />T <br />Y 19. Faclflty Ovmer or Operator CeNlicatlon of receipt of waste materials covered by this manifest except as noted in Item I a. <br />Printeelrjrped Name I Sipnatum <br />Month Day Year <br />WHITE -ORIGINAL (Raturri to Generator) YELLOW - T9DF (Retain Copy) PINK -TRANSPORTER COPY GOLDENROD --CENERATOWS COPY <br />CleanTech En vironmerlt:3i <br />�veb...[? w.ei� �..,, ^ :' <br />r,J�.f i• �' l 4 ti n, i• 5 'y <br />�v r:• <br />= .,.. �'� / .,r, / <br />, <br />1 B. GENERATOR'5 CLRTIFiGATIONt I certify the materials described above on this manifest aro not subject to <br />to or federal reguiationo for reporting proper disposal of Hazardous Waste. <br />PrintednWild Willa i. <br />/ <br />y <br />i /p�y <br />Signature 1 11 <br />.• I <br />ipp.L%.— "�"l <br />ver <br />A <br />S17 <br />Transporter Acknowtedoomenl of Receipt of Materials <br />P Printed/Typed Name Slgrlature <br />R� ' i <br />r Month Day YW <br />E 77 <br />IS. Discrepancy Indication Space IL ii. <br />F SEP 19 2014 <br />A <br />C ENVIRONMENTAL HEALTH <br />LME -PAR T WIENT <br />( <br />T <br />Y 19. Faclflty Ovmer or Operator CeNlicatlon of receipt of waste materials covered by this manifest except as noted in Item I a. <br />Printeelrjrped Name I Sipnatum <br />Month Day Year <br />WHITE -ORIGINAL (Raturri to Generator) YELLOW - T9DF (Retain Copy) PINK -TRANSPORTER COPY GOLDENROD --CENERATOWS COPY <br />