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A- M tvir=r l- <br />WHf E ORIGINAL (Return to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />NON -HAZARDOUS <br />1, Gwerator`s US EPA 10 No. <br />2. Page 1 <br />3. DOCumern Number <br />WASTE MANIFEST <br />ref <br />N° 10400 <br />4. Gonsrator's Name and Mailing Address <br />Unified Grfxers <br />IWO Piccali Road <br />Generator's Phone .oif'OriC?on! CA 9421.5 <br />S. Transporter Company Name 8. US EPA I0 Number <br />7. Transporter Phone <br />lcc)n Environmental senrices M 000 357 980 <br />S. Designated Facility Name and Site Address 9. US EPA ID Number <br />10. Facility's Phone <br />!Cort Envirf3r;nnental Sf­rvi1 ESS inc <br />?1.0476-1.74; <br />X770 Whipple Ra�,ei CAL 000 359 025 <br />Union Ci CA 44587 <br />E <br />N <br />. Wa <br />11ste Shipping Name and Description <br />t2. Containers <br />ala! <br />NQ <br />ouaMiter <br />Unit <br />R <br />T <br />T <br />a Non -Hazardous waste, liquid lei <br />C <br />A <br />b. <br />15. Special Handling instructions and Additional Information <br />Handling Codes for Wastes listed Above <br />11a <br />SEP 19 2014 <br />Clean Terh F.nvdrommentai <br />ENVIRONMENT,4L HEALTH <br />_ PART i SENT <br />18. GENERATOR'S CERTIFICATION. I Certify the materials described above on this manifest are not subiact to state or federa4rCqulations for reporting proper disposal of Hazardous Waste. <br />T <br />PrintedRyped Name l _ �,. <br />1Momh <br />Signature <br />A <br />Day?l�fer�. <br />dr <br />.- <br />N <br />S <br />17, Transporter Acknowted emant of Receipt of Mata(ials <br />P <br />� <br />Pdnted/'typed Nems <br />Signature <br />R <br />Month Day Ybar <br />�. <br />R <br />18. Discrepancy Indication Soace <br />F <br />11 <br />C <br />I <br />L <br />I <br />T <br />Y <br />19, FaclTy Owner or Operator: Certification of recelpt 0 waste materials covered by INS maniteet Z-9—PI as now In Item 18, <br />Printed/typed Name <br />Slonature <br />Month Day Yaar <br />WHf E ORIGINAL (Return to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />