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r = <br /> NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Farm desegned for use on elite{12 pitch}typerrrrter) <br /> NON-HAZARDOUS 1 Generetora US EPA ED N. Manifest 2 Page 1 <br /> WASTE MANIFEST Document No <br /> 0 S 43t1 <br /> 3 Generators Name and Meeting Address W MST COAST Qty$, LLC <br /> t ARM #4493 I= 80249 <br /> v 31. EAST CSL STRUNT R_ BANTA. MIT , 92660 <br /> = STOC KTON, Cil .95204 AT=:Kr=ICHMSTIZ <br /> 4 Generators Phone( :t (714)670-5303 <br /> 5 Transponer 1 Company Name 6 US EPA ID Number A State Trarsporter's ID <br /> DILLARD SBVIROMEMAL SV412. C A Ck,9 8 2 5 2 3B 4ar"r T Phone 9236 8 <br /> 7 Transporter 2 Company Name 8 US EPA 10 Number C State Transporters ID <br /> D Transporter 2 Phone <br /> 9 Designated Facdrty Name and Site Address 10 US EPA 40 Number E State Factlity's ID <br /> -4 ZNSTRM, IMC <br /> c-1105 AIRPORT RD <br /> ,RIO VISTA, CA,94371 IF Facrrdy's Phan <br /> (lAn 753--1829 <br /> 11 WASTE DESCRIPTION 12 Containers 13 14 <br /> Total Unrt <br /> No Type Quantity Wt1Vot <br /> a NOW HA8 DECOR IMT&R, XONK,r (gf. ,) r f <br /> (T1 D M �� <br /> E 1 bs <br /> R c <br /> A <br /> T <br /> O <br /> R d <br /> W <br /> G AddMonat Descriptions for Materials Listed Above H Handling Codes for Wastes Lsted Above <br /> 11a. <br /> O =11b. <br /> 11a. <br /> p lid. <br /> Di <br /> a <br /> Q15 Special Handlrng Insinrctions and Additional lntwmabon <br /> Z Sffirgatl Cantaat(=25)93—�0 DILLARD <br /> �r 0 <br /> 0 <br /> z <br /> 16.GENERATOR S CERTIFICATION I hereby ceAily that the contents d thea shiprnerd are trAly and aoauately deacnbed and aresin all respects <br /> in proper condition for Transport.The matereals described on ttxs manifest era rwA <br /> sub= <br /> rei hazardous waste regulato <br /> Date <br /> P.rintedlTyPed Name Mortfh Day rear <br /> 3 <br /> T 17 Transporter 1 A&nowledgerrwreot Receipt at Materials Date <br /> R <br /> N a1 Day Year <br /> s <br /> P 1 Transporter 2 Acknowl <br /> O edgement of Reoe+pt "a Date r <br /> TPnntedlTypedt � t Signature JNomb Day Year <br /> E <br /> R i <br /> 40 F 19 Dracrepencyln8oaton Space <br /> A <br /> C <br /> 1 ��r or Operator Certrficaton of receipt of the wasto matenals covered by thes manifest except as noted in item 19 <br /> L <br /> Date <br /> T Prvrtearyped N�b�� segnature Dar rear. <br /> Y '�1,.1177 1-1 <br /> g llCF14 02002 LA[E.lP'1ASTEA e IsooY 921 58d8 wnw labeknaster corn �.rrtoartt'umr�r[e <br />