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i S WASTE MANIFIST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) 2.Pae 1 <br /> ' <br /> I.Generators US EPA ID No. Manifest g <br /> NON-HAZARDOUSDocument No. 8 2 9 Q 5 of � <br /> a WASTE MANIFEST <br /> 3,Genera[riT.'s Name and Mailing Address 1$$T _ Ii7'E.$�`'PTf'. lkTf'.iiFTg'T,�T4 <br /> LRM 0760 PO'$OX 9087 <br /> 225 S. CHBROME LOS ANGELES, CA 90009 <br /> LODI, CA ATTIE: PAAFL SrMI E <br /> r 4.Generators Phone.( (925)946-1085 <br /> 6. US EPA ID Number A.Slate Transporters ID <br /> 5.Transporter 1 Company Name <br /> �3` DliJ�tD E�IROffi�R'TBI. SSFCS. CBD 9 8 2 5 2 3 4 3 B- <br /> Transporter 1 Phone 925)634-6850 <br /> ;tr 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> } 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> s <br /> IAC. T.i.L <br /> 9999 SOUTH AUSTIN ROAD F.Facility's Phone <br /> 'ECA, CA 95336 <br /> C g I, Q 0 D 1 9 D 0 8 0 (209)982-4298 <br /> ., 12. Containers 13. 14. <br /> 11.WASTE DESCRIPTION Total Unit <br /> s No. Type Quantity Wt.Nol. <br /> t a. EOU HAS SOIL, (Pf: 2317) <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R d. <br /> Ldp <br /> •,. H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> 7 Alm. 2 318 <br /> 1141- <br /> 11d. <br /> 15.Special Handling Instructions and Additional Information <br /> Rieezgencg Contact (925)63'1-6859 DIIii <br /> JUBf 1007-443 <br /> AW A111111111111,11''.. _11111i <br /> .;. <br /> aw <br /> ERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately de ibed and are in all respects <br /> 16.GEN <br /> .' n this manifest are not subject to federal hazardous w e regula, <br /> ions. <br /> in proper condition for transport.The materials described o <br /> Dale <br /> Sig t r t ni_6� <br /> Printed/Typed Name <br /> - <br /> P. DILZARD PER ARCO <br /> Date <br /> T 1 ansporter 1 Acknowledgement of Receipt of Materials _ <br /> R Signature H fh D3yy Year <br /> A Pr d/T?ped Name <br /> IN <br /> p r <br /> S Date <br /> P <br /> p 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Signature Month Day Year <br /> Printed/hyped Name <br /> E <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> S ' <br /> 20-Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. % <br /> L Date <br /> C <br /> 'r PrN <br /> Signature nth Day Year <br /> intedfTyped <br /> ®gMf1ED0M nECYCEEO VMEnr •"INI( <br /> CF i 4 IA.@ELAAST1X&1800)621 waw.taDetmaster.com <br />