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N.-,04-HAZARDOUS WASTE MAIC.�ST <br /> Please print or type (Form designed for use-on elite(12 pitch)typewriter) Manifest2.Pae t <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Document No. 9 <br /> S 2 O 3 01 <br /> WASTE MANIFEST <br /> 3.Generators Name and Mailing Address )WI: ATLANTIC RI�'K IZLD <br /> B�Lt$) 736t) kO SOX 90183 <br /> 1 225 S_ i tEPOIZE LOS ELE S, £A 90009 <br /> IADI CA ATTN: PAUL :UPPF� <br /> 4.Generators 15hone( 4425 94.6_1085 <br /> 5 Transporter 1 Company Name 6. US EPA ID Number A.State Transporters ID <br /> _ -, .Transporter 1 Phone ---@— a 5 D <br /> -a <br /> 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 /> g ORMISAD loc. LAID ILL <br /> 9999 SO Ullf AUSTIN ROAD F.Facility's Phone <br /> CA, Czl .93336 7_ <br /> r 1 <br /> 4298 <br /> 12. Containers 13. 14. <br /> 11.WASTE DESCRIPTION Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. 909 d" SOIL, (P£: 2:317) ' <br /> G 7 <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R <br /> W <br /> H , <br /> H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> I <br /> On 2 -?37 '' <br /> cc <br /> Q <br /> 15.Special Handling Instructions and Additional Information <br /> ?Wery--ucq ronf`Rc1 f 925)63 -685U flII L*yRi <br /> Z Ji7Si� lU0)7-3�3 <br /> 16.GENERATOR'S CERTIFICATION:: h>Icertffy that the contents of this shipment are fully and accurately dgscribed and are in all respects <br /> ,y in proper condition for transport.The materials described on this manifest are not subject to federal hazardous lNas <br /> Ate regulations. <br /> �� rl <br /> y � � Date <br /> Printed/Typed Name / Signa �..n! f /J� M �a) J l.T Year <br /> 1 n ILL,tlit!'+ PER ARLI) <br /> Date <br /> T 17.Transporter t Acknowledgement of Receipt of Materials <br /> Printe Na �/ � <br /> MonthDay Year <br /> N Yp <br /> S <br /> Fr I Date <br /> 16.Transporter 2 Acknowledgement.ot Receipt of Mate Is <br /> Signature Month Day Year <br /> R PnntedrTyped Name <br /> T <br /> E <br /> r R� <br /> 19.Discrepancy Indication Space <br /> F <br /> 1 I 20.FacilityOwner or Operator;Certification of receipt of the waste materials covered by this manifest.except as noted in item 19_ <br /> L ` ` '/ <br /> � Date <br /> T I Pnnted/Typed N Signature77, <br /> plorrjh Day Year <br /> ®rnwroor uraaro..o[n- -u«:,,;w <br /> USNG SO+BE+M rw _$pYNK <br /> CF14 I.?B1Lt$lr.STIR(D(600)621-5M --W)ermasW-com <br />