Laserfiche WebLink
• • RECEIVtu <br /> NON-HAZARDOUS WASTE MANIFEST FEB 01 2016 <br /> PI dnntortype (Form designed for use on elite 112 Ptah)typnvdler) ,3��1 <br /> NON HAZARDOUS 1.GanamWes USEPAIDNo. Manifest No. CME <br /> WASTE MANIFEST HEALTH DEPA d <br /> 3.Generator's Name and Mailing Address F \O rG A'C .7>*" A I1 . ' <br /> Yr <br /> 4.Generator's Phone l 1 �3TGG .TQtJ CA <br /> 5.Transporter l Company Name <br /> lI 6. US EPA ID Numbar A.Slate Trasporter's ID <br /> �NS•!'n:Fi't t'O+ 8.Transporter l Phone <br /> 7.Tmspwter2 Ccmxny Noma S- US EPA ID Number C.Slate Transporters ID <br /> 0.Transporter2 Phone <br /> S.Designated Facility Namo and Site Address 10. US EPA ID Numb" E.State Faddys 10 <br /> F.Facitty=s Phone _ <br /> RID.49J . <br /> 11.WASTE DESCRIPTION 12 Containers r'3. 14. <br /> Total Unit <br /> No. Type OuantNy WINnL <br /> a <br /> G In. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R o <br /> G.Addnbmal Descriphos for Materials Listed Above H HerrNng Codes for Wastes Listed Above <br /> I <br /> 1S.Special Handling instructions and Additional lnfomnadan <br /> IAWAWANAWAWAWAWAWAWAWAWAWJWAWMAWAW <br /> ment are Iy <br /> re in <br /> 16 np peGENEter conditionEor varsport The malenzk tlesenbMhonnamannis�est are nl this ot subject to edema hmrdoand us xaaste regulations. all respetls <br /> Date <br /> PrinledfTypsd Nam Signanm Month Day Year <br /> —ttrTrarrsporkrYAckrwwledgement OReceip4oFMatenae r <br /> A ,p! l�nied/Typed Name % a Signature ' month Day Year <br /> J r' <br /> N <br /> IS <br /> P IS.Trasporter2AcwmrsiedgempniNReceiptol Materials Date <br /> • T pnmeru Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 120.Facility Owner or Operator.Cemliceilon of renaipl of the waste malerinV covered by this mardicst.except as noted in ilem 19. <br /> L Dale <br /> T PrimeoRy�ppedqtName 'Signature I r . ? Efwrrh Day Year <br /> Y 7 1tCH0E LiJ)hr-EiICAJ <br /> aEs <br />