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AM mvRoNMENTAL <br /> QS♦urocE5,m <br />�ae - _,z---c — - - --� _ -- � � -- - - Vii■ �Y�VI. � -- � -- _ _ - -- _- - _ _ ___� _��'_- __-_ �- <br /> k,%'i r�t4m, <br /> V�CA SM7 <br /> m g �ist# �F+ � B f 754-2'788 <br /> L ad Im s <br /> 4 'r ' <br /> NON-HAZARDOUS y t cf� star (} FPt jD�rq , ! E =D.rntsNo 2 Page 1 <br /> r aWAN5TE MANIFEST of <br /> 3f'Ileo l°cts 1'OTegrg to fAlp Address 1649 Channell St <br /> - ) 1Jk� 1CI3 Stockton Ca 95205 Stockton , Ca <br /> -- <br /> 4 Generator s Phone{ 119 465 3609 <br /> a y 5 1 rar �rferti �ofneany!�QI'�[-k 7 rk C _ _ 6 by US EP,�A ID Number ` 8 ) 927-932 , <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> 9t De5i1 1�jed �acr�lty N r�v gfid154te Ad�resC }0 US EPA ID Number A Tronsporter's Phone <br /> B Transporter's Phone <br /> 451-3276 <br /> 11 Waste Shipping Name and Description 12 Contorners 13 14 <br /> Total Unit <br /> No Type Quantity Wt Vol <br /> I,: I y arr}cartc r+ :-,0i I , AC.t Ear l 4 0 1 1 5 1 Es yC191 <br /> WEIGMUSTER CERTIFICATE <br /> THIS IS TO CERTIFY that the fotowil described conwriodity waa weighed measured,or counted by a werpTmasler wMoee aipnatuto is on"eerfllkats who Is a mccirLod auth°r(ly c1 ac,", pa prescribed by <br /> Chapter 7(corixr,erl ril Section 12700)of Division 5 ol Itw GYtarn4 8usirl and Psolriasbna i ode aCminYr[ered by Ihe�ivision of Meaaumneru Standards al the Callprn4 peparbnanf of r-ood and Agriculture <br /> rWj <br /> s A rI 'r' "i. ( c f ICKE'l N[.1. I 76720 �a <br /> 11-, k milt / i)i Vi-10jiment Co. DALE: DEC 1, 1593 9 .46 :4-1 <br /> Idk' 1 [I ,i ci In L 'i._( ilz y Rl. VacCFkvi i l e, (,a 'Cc,rllslodity :C-SOIL <br /> ! it^1ce/Unit : <br /> Ips k 144i 1 i; I`dllh[ I1,3w"11��a{ t <br /> / /up / <br /> iota1 Charge : <br /> ! 1 I endey-ed W. 140 <br /> III tlli,lw Change : to.. vii <br /> f /F480 (11) ter u, b WL I [list Lbt�. <br /> ,_9700 _ iEli t- W � auht Ahs. - - - - - - -s- <br /> -4b7aO [I[eL Lite i i,ht Lb, . SANDY HALL <br /> ply pg NI!`wF <br /> 1 : {a'}F2J Ic L CF`a. '- Y,tic, 0 u .]I 1 DEPUTY WEIGHMASTER <br /> 16 GENERATOR 5 CERTIFICATION I cal the matenals described above on this mamlest aro of eN to f 1 regulations for reporting proper disposal of Hazardous Waste,,i <br /> Printed/Typed Name Signature Month Day Year ry; <br /> a ;u i3t tr,1- M I d ( a L.685ing 12 Q1 3 ' <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials R` <br /> f1 <br /> A Printed/Typed Nome Signalur Month Day Y or <br /> N <br /> N <br /> <a <br /> q 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R )I <br /> E Pnnled/Typed Name Signature s Month pay Year` � <br /> RA <br /> 19 Discrepancy Indication Space ' <br /> F <br /> A <br /> C <br /> I - - - <br /> 1 20 facility Owner or Operator Certification of receipt of waste materials covered by this ifest except as noted in Its 19 <br /> T <br /> Y - - _-�___--..-----. 4 <br /> Printed Name Sig nl Doll),IN, , Oil II <br /> s'1�1ra` a TRANSPORTER #1 <br />