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9 <br /> N0N-HAZAHD0U%-_-3) WASTE NLANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewnier) <br /> NON—HAZARDOUS 1 Generator's US EPA ID No Mandest 2 Page 1 <br /> WASTE MANIFEST Document <br /> 1 2 1 7 3 orf Z <br />`l 3 Generator's Name and Matting Address }GYM- BP � ST MA T PRMUCTS, <br /> XU <br /> 40 ARCO #4493 P.D. BOMB 8024+9 <br /> 705 XaM CZJ1 ZR S33 EXT SOW ST. MARGARITA, CA 91,600 <br /> XTOCZ 1r, CA A=: Z= EMUSTIE <br /> 4 Generators Phone( 'l14 671}—�3�13 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A State Transporters rD <br /> 11II.T.BRy1 ER4IRC>�lTAL SVCS.. C A D 9 8 2 5 2 3 4 2 B Transporter 1 Phone (925)634—GWO <br /> 7 7ranspOrter 2 Company Name 8 US EPA ID Number <br /> C State Transporters ID <br /> D Transporter Phone <br /> 9 Designated FacUlty Name and Site Address 10 US EPA ID Number E.State Facilrtys M <br /> INVZ2=, Inc <br /> 11,05 C AIRPORT RD <br /> RIO VISTA, CA 94571 F FacflWs Phone <br /> (530)733-3B29 <br /> 11 WASTE DESCRIPTION 12 Containers 13 14 <br /> TOW Unit <br /> No Type Quantify WtNd <br /> a. mor WAR PURM M=, (prf: ) V <br /> D I I I G <br /> G b <br /> E <br /> N <br /> E <br /> R o <br /> A <br /> T <br /> O <br /> W <br /> R d <br /> F <br /> W <br /> G Additional Descriptions for Materials Usted Above H Handling Codes for Wastes basted Above <br /> IV <br /> 77w. <br /> M 33b. <br /> p 11c. <br /> a <br /> N 15 Specie[FWwVng Instructions and AddrtSonal Information <br /> = Ettttesgeaey Contact (925) -8850 DZLX ,RV <br /> Z r]r# 1-097 POO ARCO2003 <br /> Z <br /> I&GENERATOR'S CERTIFICATION I hereby rtdy that the contents of Iles shipment are fu and aceuratel� re m all respects <br /> in proper contlitbon far transport.The mat described on this manttest are not subiect aste regulatlo <br /> Date <br /> , <br /> PrtnteName Month Day Year <br /> ROA[�[ BER ARCO�P <br /> r. <br /> TT 17 Transporter 1 Adurowledgemant of Receipt of Matelots <br /> Date <br /> Yrrz� Ayped Name Signature <br /> MortM Day Yr <br /> P <br /> i Rp 18 Transporter S 1:1 04Y <br /> 2 of Receipt of Materials Eleta <br /> TE PdntarYTyped Name Sw ature Month Day rear <br /> R <br /> 19 Discrepancy Indlcatbn Space <br /> F -, <br /> } C <br /> L 20 FadUtY Owner or Operator Cantlicadon of recelpt of the waste materials Omred by this mandest,except as noted in item 19 <br /> L <br /> jf7 f <br /> Data <br /> YDay Year <br /> F CF14 G 2002 LARELAASM CO (60p)621 SUMS www labeirnaster cam <br /> G � m <br />