Laserfiche WebLink
[� NON-HAZARDOUS WASTE MANIFEST <br /> Please Pent or type (Form designed for use on elite 112 pitch)typewriter) <br /> NON—HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Pagel <br /> Document No <br /> caL.aoao09ss2 of x <br /> WASTE MANIFEST X330 <br /> 3 Genas Ha and Mailing Address - PO S= IMT <br /> BM49 <br /> 900 S Cmmmz L= R. SMTA NUMITA, CA 926 <br /> EWI, CA 95240 Arm: E= EMISM <br /> 4 Generators Phone( (T�4)670-3303 ffiF36020203 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A State Transporters ID <br /> DILTJ= ZMRORIWNTAL SIC$ C A D 9 8 2 5 2 3 4 3 2B Transporter 1 Phone <br /> 7 Transporter 2 Company Name 8 US EPA ID Number C State Transporters ID <br /> D Transporter 2 Phone <br /> 9 Dessat�Tdy Name and Site Address 10 US EPA ID Number E State Facility s ID <br /> 33105 A191K= RD <br /> ILIO VISTA, CA 94573 F Facltlty's Phone <br /> (530)753-IB" <br /> 11 WASTE DESCRIPTION 12 Cc, hers 131al 14 <br /> Unit <br /> No Type Quantity V"01 <br /> a N= M IMM, Wn, (pf: ) <br /> 00 DK 0003 3 6 <br /> G b <br /> 1 E <br /> N <br /> C <br /> R c <br /> A <br /> T <br /> O <br /> R d <br /> W <br /> G Additional Descriptions for Materials lasted Above H Handling Codes for Wastes lasted Above <br /> N Iia. I <br /> 3.1b. <br /> Q 22C <br /> I <br />' 16 Special Handling Instructions �Additional Infamlation <br /> Eu= 6 <br /> aM**�4 P06 DIIJARD(925)634-68506850 DiLLUD <br /> Z <br /> Z <br /> 16 GENERATOR S CERTIFICATION I hereby eer6ly that the contents of rtes shrprneN are fully and accurately desarbed and are m all respects <br /> in proper condition for transport The materials described On this rnamfe5l are not subject to federal hazardous waste r laflons <br /> I <br /> Date <br /> Pnnte&Typed Name Signature Month Day Year <br /> 74 -q j0q <br /> TT 17 Transporter 1 Acknowledgement of Re&pt of Materials Date <br /> A Printed//T'yped`N'a�me Signature Month Day y <br />' N cad <br /> o <br /> P <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials Dale <br /> T Pnntedrryped Name Signature Month Dray Year <br /> E <br /> Discrepancy DiscrepanIndication Space <br /> A <br /> C <br />' L 20 Facility Owner or Operator Certification of receipt of the waste materials covered by Om manifest except as noted in Item 19 <br /> Date <br /> T PnntedrrYfied NameSignafur Month Day Year <br /> Y Zr— ax h C// 4 _ 9 1 �_Plb I CL <br /> CF14 X2002 LQ0J ASM0 (80oj6215808 wwwlabelinulercom 0 up i�rcrnmrurw wQ <br /> y�f vAF.wf I NrK <br />