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1 • 0� <br /> NON-HAZARDOUSWASTE FA <br /> please print or type (Form designed for use on elite(12 pitch)typewriter) Manif2.Pae 1 <br /> 1.Generators US EPA ID No. Document <br /> g <br /> NON-HAZARDOUS Documen,No. <br /> 3' S 2 9 ® 3 of <br /> WASTE MANIFEST <br /> 3.Generator's Name and Mailing Address I,. IC IRIL WIELD <br /> .CSD 0760 PCI Box 9Ql' <br /> 225 S. 0 RO E LOS a ETZ C8 900019 <br /> LO DI CL MTN: PAUL S13PP'M <br /> 4.Generators None( (925) <br /> 6. US EPA ID Number <br /> 5.Transporter 1 Company Name A.State Transporters ID <br /> Transporter 1 Phone _ <br /> 7.Transporter 2 Company Name B. 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 /> g(?4 IffiC. LAMFILL <br /> zy. <br /> 9999 soy= AUSTIN ROAD F.Facility's Phone <br /> — KAMCA, CA 95336 _ <br /> 12. Containers 13. 14. <br /> Type Quantity Wt.Nol. <br /> 11.WASTE DESCRIPTION Total Unit <br /> No. <br /> T 'a. scow KM SOIL, (pf: 2317) <br /> G b. <br /> E <br /> E <br /> R C. <br /> A <br /> T <br /> 0 <br /> LLJ '' d <br /> k <br /> H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> 11b <br /> .-- 11d. <br /> 15.Special Handling Instructions and Additional Information <br /> E $gr-ncy Contact (925)639-6050 TaIIs. S <br /> MIAW <br /> w <br /> _ a <br /> 16 GENERATOR'S CERTIFICATION I hereby certify that the contents of this shipment are fully and accurately d s gibed and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous a to regulations. <br /> Date <br /> Year <br /> Printed/Typed Name Signa 7 M 2a <br /> P. IDILLARID PER ARCD -0 <br /> Dale <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R Signa e / n Month Day Year <br /> A r.:a�.yp dNarra <br /> 1 s a ,�� <br /> P Date <br /> O 18.Transporter 2 Acknowledgement4t Receipt of Mate' Is <br /> TPrintedrfyped Name Signature Month Day Year <br /> E <br /> R <br /> 79.Discrepancy Indication Space <br /> F <br /> A <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> Date <br /> 0 - - Day Year <br /> T Printed/typed N <br /> Signature <br /> y ALJ <br /> wWcE r,!YEN� "INK <br /> CF14 IAPEL 9 SMCE )(W0)621-5W6 'l"balm"ter.com <br />