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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Genwarlcf s US EPA ID No. No Document 2 Page l <br /> WASTE MANIFEST r_AC002769415 €t55935 of � <br /> 3.Generator's Name and Mailing Address <br /> Levaand-13kht Trust <br /> 3 E.11 th Street <br /> Traits*CA95376 <br /> 4.Generator's Phone( 2W9694709 <br /> V'7 <br /> 5.Transporter t Company Name 6. US EPA ID Number <br /> tyht�yl� ,i(s A.State Transporter's ID <br /> Advanced CherlflCl9l Tranapw kim.J� CARO"10540 P 408-,%8-5050 <br /> 6.Transporter t Phone <br /> 7.Transporter 2 Company Name 8, US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number F_.State Facility's ID <br /> Advanced Chemical Traansport,Inc.(Mcd) CAL)00336454 <br /> i< <br /> 26S Riggs AAA! F.Facility's Phone <br /> f. <br /> Merced,CA 95341 209-722422H <br /> 11.WASTE DESCRIPTION Containers 13. 14, <br /> Total Unit <br /> No. Type Quantity WI..NoI. <br /> NON DOT REGULATED MATERML,MUD <br /> TT <br /> G b. <br /> E <br /> N <br /> E <br /> R C' <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> G.Additional Descriptions for Materials Listed Above 11.1-landling Codes for Wastes Listed Above <br /> Q Pr4ecl Number 49078 <br /> 1)ERON;ACT29933 L ( 't 7' Q <br /> 0 <br /> CC 15.Special Handling Instructions and Additional Information <br /> Q <br /> Q <br /> r <br /> '. <br /> 2 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in,all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Type Signet r r� _MO Day: Y r <br /> 62 V <br /> T 17. Transporter t Acknowledgement of Receipt of Malenals Date <br /> R <br /> A f d Nartm S cont Day Ye <br /> �-- -- p Y <br /> O 18. Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R <br /> T Printed1Typed Name Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> 1 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 /> T Pri ype�f me Signature M th Day Year <br /> Y pJg P !� <br /> CF14 ©2002 LABELI"IASTERG (800)621-5808 www.labelmaster.com <br />