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ALTA ENVIRONMENTAL SERVICES, INC. <br /> -83,1 Davis St -- -- <br /> i; r 11hy V�r�e CA2M7' �'a it k : (8W)7542768 <br /> ' fFN= <br /> artrl rgiyryyll, bsbcn Atr 1 <br /> NON-H AZARDOUS I G'y yr orj 1R6P ) eta G DoMmeMst 2 Page 1 <br /> WASTE MANIFEST of <br /> 3,yICitLer�lor s{vailr ,A—M 4 Address 1649 E . Channell S t <br /> ee W <br /> "r ante„ -5103 ztackton , C'a 95?05 Stockton , Ca <br /> 4 Generator s Phone( z�,l 465-3609 <br /> 51Tran�pWSelrd Fa1 Pal IrATTE k i l i Q 6 N IP EKA ID Number (4 0 8 ) 927-9321 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number \ <br /> 9� DesivtiRled FacLla l*ag,l q'sd Sole Ad}frAsl, t0 US EPA ID Number A Transporter's Phone <br /> j*J H„��/ I,tl1 di GI l ii f� B Transporter'ss�Phone <br /> I E, C a C Fanlity�Pltgp� 451-3276 <br /> 113 14 <br /> 1 Waste Shipping Name and Dewipfton [C12 QVColntatners Total Unit <br /> No Type Quante wt vol <br /> u,Ir,I1-t3�zarU��Lih hydroc&rlipn -impacted 5,-)i1 AC EPT 4 011 S__ __ _ 113 yds _ <br /> WEiGHMASTER CERTIFICATE <br /> THIS IS TO CERT IFY that The following described conxriodity was walphed measured or counted by a weigrmaster whose ssi12nature is an this certlicato who Is a reoogfti4ed authority of accuracy as prescribed by <br /> Chapler 7(commencing wv th Section 12700)of Drvwon 5 of Ina Caklornis Business and Prdessbns Code administered by the Dwi sion of Vassuremwd Standards d the California Department of Food and Agriculture <br /> rILKFT NO. s 76754 <br /> Fri 1 t'iliti y Devk lopillent CA. DAIE—. DEC 17 19,33 1`:� 3. 4., <br /> 1JL" _I,i, ti 111 ( rr_1 llay/ Rd. vacLtvi t le, Ca. Colit inc)dity :C:-COIL <br /> Pr T f-w:1371 1.t ; <br /> lir I IF1f t rtr�l�[,I � Ili lf�l:Ak_�N � / <br /> Tendered : 1i�l. t its <br /> VA,— I 1 l LI Change : ob. I,10 <br /> 'a(.} t t rl i:11 i 1,;-i <br /> /91Z14L4 (t1) rid cly HL-Liltit Lb! <br /> — <br /> A 140 I G.,ro W,- I titti. Lbb. <br /> f- 7 =r(-)`)CA0 I t- t 4!e I til it L1r-�. �(llaDY I IALL <br /> OffiXMIWGNAT I t Ilk DEPUTY WEIGIiMASTER <br /> 16 GENERATOR'S CERTIFICA71ON I certify the materials dew,bad above on ills manifest are sub9Fs-W federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Ty ed Nome Signalur Month bay Year <br /> �gerit for M-id C& I LetaSing f'' Z i 1 <br /> z <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> APanted/Typed Name Signature --"7 nW !✓Dpy 97, < <br /> S G / a <br /> P <br /> p 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature iNanfh Day Year <br /> E <br /> R <br /> 19 Discrepuncy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 1 20 Facility Owner or Operator Certification of receiP7 waste materials covered by this anifest except as noted in Item I9 <br /> I <br /> T <br /> Y <br /> P Ty ed N Signotur M <br /> k <br /> TRANSPORTER #1 <br /> J <br />