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r4 <br /> Please prant or type <br /> (Farm designed for use on elite(12 pitch)typewnter <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Page 1 <br /> WASTE MANIFEST NJA Document No <br /> r r n °f <br /> � 1 <br /> Generator's Name and Mailing Address - y <br /> Slaty Sales Inc. <br /> P.O. Box 903; Barrego Springs Cat 92004 <br /> 4 Generator's Phone( 760 ) 067-0776 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter's Phone <br /> la I 7.Y �_ R lr <br /> 7 Transporter 2 Company Name 8 U$EPA ID Number 8 Transpor er's Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility's Phone <br /> WESTERN LI'VIRONMENTAL Inc. <br /> 62-150 GENE TdI.0 AS DRIVE <br /> MECCA CA 92245 A R 0 0 0 1 5 T 200 6 (760) 396--0222 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity Wt Vol <br /> a <br /> f r <br /> ' on—llaxardous Waste Solid (sail cuttings) [0 DM 0 0 5 5 0 Y <br /> G b <br /> E <br /> N <br /> ' E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> d <br /> D Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> 15 Special Handling Instructions and Additional Information <br /> We3,r appropriate clothing, steel toed boots, & gloves, <br /> Emergency 24 hour phone (8$8)701-6600 <br /> Site@Stelano's Gas Station (AGE) <br /> 1419 E. (Charter Way <br /> Stockton Ca 95209 <br /> 16 GENERATOR'S CERTIFICATION I certdy the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year <br /> i f 94rliw A(1117 <br /> T 17 Transporter i Acknowledgement of Receipt of Materials <br /> R `Y <br /> NPanted/Typed None Signature f Month .Dar; Yeor <br /> i $ Y( <br /> P <br /> q 1 B Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy indication Space <br /> F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y <br /> Printed/Typed Name SignatureMonth Day Year <br /> J r ` <br /> �t i ' i � 1„r ✓ r� x`.._. f <br /> Ppnted by J J KELLER&ASSOCIATES INC <br /> Neemeh WI 54957 0368 C®Pl' 12-BL.0-M6 <br />