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NON-HAZARDOUS WASTE MANIFEST .4649936411140 <br /> Please print or type (Form designee for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generalors US EPA ID No. Manifest 2.Page 1 <br /> WASTE MANIFEST PE:H D 1 N G 0 2 .1 Document No. of <br /> 17. <br /> .Generator's Name and Mailing Address <br /> Generator's Phone( ) <br /> .Transporter 1 Company Name 6. US EPA ID Number A.State Transporters D <br /> h 1• -. <br /> 932 - B.Transporter 1 Phone <br /> Transporter 2 Company Name B. US EPA ID Number C.State Transporters ID <br /> D Transporter2 Phone <br /> .Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> ARAIN ehlt 4 f111 <br /> 10S40 Amt P*"R0� C A 13 ff iA <br /> F Facility's Phone <br /> Livern-wr .CA 9411580 <br /> 11.WASTE DESCRIPTION 12. Containers 13, 14. <br /> Total Unit <br /> No Type Quantity WVvol <br /> a. WWNAMD0tJSr W)N W i 1 '111(AM t4!F.!a 1_1QUI1tr W RWM E <br /> MARn ART <br /> G b. <br /> E <br /> N <br /> F. <br /> R <br /> A <br /> T <br /> O <br /> W <br /> R d. <br /> H <br /> N <br /> aG.Additional Descriptions for Materials Listed Above H Handling Codes for Wastes Listed Move <br /> 11e.61 00tti(:A <br /> D <br /> 0 <br /> cc <br /> < __ <br /> Q15 Special Handling Instructions and Additional Information L16L4 -6ae_ j :I11,JUL 46 <br /> GEWPATOR.Hunat RetBcdwa <br /> z <br /> 0 <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Typed Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Printod?yped Name ` Signature Month Day Year <br /> N <br /> S rpt.•;.( <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R PnniedlT <br /> yped Name Signawm Montt) Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 2C.Facility Owner or Operator.Certification of receipt of the waste materials covered by this manifest.except as noted in item 19 <br /> Date <br /> T PnnletVTyped Name Signature Month Day Vear <br /> Y <br /> CF14 Sr 2002 LASELAASTUs(600)621,5806 wwwlabelmasler com ®nun¢onwaaro•.rte® ,..... <br /> �+4 SO+lfM r/ <br /> T7 Si <br />