Laserfiche WebLink
n <br /> NON-HAZARDOUS WASTE MANIFEST <br /> Please pnnt or type (Form designed for use on elite 112 pitch)typewriter) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No e Document No 2 Page 1 <br /> WASTE MANIFEST Of <br /> 3 Generators Name and Mamng Address !MAIL: PP 1VJT CDA= PRODUM I= <br /> ARM 923M P.O. ESC W249 <br /> 3M P. CmLjjUgIa RAW= S!_ MUMMYT,A, C& 9 <br /> 4 GeTOMMneralors ( CA 932" A=: � GMI'X= <br /> .1t4 asv-ssos <br /> 5 Transporter 1 Company Name 6 US EPAJONumber 7A. te Transporters ID <br /> D nsporter 1 Phone <br /> 7 TranspaAer 2 Company Name 13 US EPA ID Number C State Transporter's ID <br /> D Transporter 2 Phone <br /> 9 Designated Fadlrly Name and Site Address 10 US EPA ID Number E State Fadidys ID <br /> =10%I= x= <br /> otos C iIRPMRD— <br /> RIO VIffA, Ca 94371 F FaciTi3 Phone530 53— 29 <br /> 11 WASTE DESCRIPTION 12 Contairier8 13 14 <br /> Total Unit <br /> No Type Quantity WtIvol <br /> a P[1R 1fJlS 1fG—OQ�i �, (pg: ) <br /> G b <br /> E <br /> R <br /> E <br /> R c <br /> A <br /> T <br /> O <br /> W <br /> R d <br /> G Addnional Descriptions for Materials Listed Above H Handling Codes for Wastes Lasted Above <br /> IIS. <br /> Lill. <br /> O I1c. <br /> lid- <br /> CX <br /> N15 Special Handling Instructions and Additional Inkwrnabon <br /> ttmgmimr Contact 000 673" DILLUD <br /> 0=f 1-230 rM Arco 2003 <br /> Z <br /> 16.GENERATOR S CERTIFICATION I hereby oertity Shat iha contends of 1Ms ship" rrt are IuMy and aoauatey described and are In an respects <br /> tit proper condition for transport The mate desa�ed on this manliest are not sub)ect to rat taazardous waste regulations <br /> Date <br /> PruHed/Typed Name Signature Month Day Year <br /> R 17 TranspoAsr 1 of Materials Date <br /> A PrnrtediTyped Name Signature Marrfh Day Year <br /> N 1 <br /> 5 <br /> P <br /> C) 18 Transporter 2 AdumMedgement of Receipt of Materials Date <br /> R Printed7yped Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> 20 Facility Owner or Operator Cedrliration of receipt of f11e waste materials covered by rias manifest except as noted in Nem t9 <br /> Sr Data <br /> TiPrintedrTyped Name Signature M Day Y <br /> Y �v / 3d 6 <br /> C'F14 0 2002 LABELAATMIP(m)6213808 www labolma ser com <br /> yyK rQraFMM "IN![ <br />