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NON - HAAZARDOUS WASTE MANIFEST <br /> ..6 <br /> PROFILE NO. <br /> ND 11997 <br /> 1-800-458-3036 <br /> 0 BAKERSFIELD 0 YOLO 0 PHOENIX <br /> NOTE: This form to be in lieu of the Toxic Substance Controls hazardous <br /> waste manifest. To be used for NON-HAZARDOUS WASTES only. <br /> 1V IV MSV IVHNHHHHIVHHHMV1VHH -V71V MIV IV V NIVNNIVNN NNNNNNNN/V/VNNN/VMN <br /> Name : L/&YieOAt TI�E,L/NE <br /> Mailing Address : 1;5y4 C,44/NA Gi2AP6 LOOP <br /> LU City/State/Zip �iEKE25 f/EL I7 GA Q 5308 <br /> Z <br /> LU <br /> Phone No 66/ 39/-S3 S0 Contact : 77f4 ZA.vpE.e <br /> M Signature: X Date: <br /> G <br /> F THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> LU <br /> IL Waste Description : //ryD)WC✓EA$on/ . /7 ;5C1,,4Zdy, 'CTEG WIL)eOKIS <br /> 2 <br /> V Generating Location I OS J­fEDAVV5 KLAN a"C I.V6 7 g*ayl <br /> M Handling Instructions : /✓OiJE <br /> O <br /> Quantity : 6;& 1 1BBL I 1GLS ><YDS I ]TONS <br /> CONTAINER TYPE: I ITANKTRUCK >qDUMPTRUCK C ]DRUMS C ]BINS C ]OTHER <br /> DESIGNATED FACILITY : ^ , <br /> NAME : A47,*No.JT ADDRESS : /081/0 /}llhAdo.�%�ifsS Kq, <br /> CITY/STATE/ZIP: /✓E.¢,6tOeE CR 9yfsp^ I!'fZ,� PHONE# -ys-✓5-ul !3� <br /> 2 <br /> MP VACUUM TRUCK SERVICE TICKET# TRACTITRLR# / <br /> MP ENVIRONMENTAL SERVICES, INC. Bin No's <br /> d3400 Manor Street Signature: <br /> Z Bakersfield,CA 93308 Date <br /> Q 805/393-1151 P/U DATE: Job# <br /> 2 <br /> F <br /> Name : Disposal Method <br /> Address : ❑Landfill Other <br /> City/State/Zip <br /> V <br /> LL Phone No : Time : am <br /> N Discrepancy : <br /> Pm <br /> H <br /> Signature : Date <br /> GENERATOR RETAIN <br />