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STAIWO, ING <br /> TO BE USED FOR: P1ON-HA7,.AR00Uc_Z <br /> GENERATOR: WASTE, TO BF 1)TSF-SED, <br /> NAME: FACIFIC GAS & ELECTRIC CO . TYPE : NON 1117ARD"(JS Soil <br /> ADDRESS: 4040 WEST_LANE _ .711T <br /> SITE LO+','ATTWJ : 40 Ito PEST i.A!;E, S1ON CA <br /> ;L J <br /> CITY, STATE,ZIP:_STOCKTON, C.A.. `35204 SPECIAL 11ANT))_,JNC- INSTUC9 TONS : 14C)N-11-1 <br /> PHONE: _11 <br /> - 40UZ63-5212 ___(�'LOVES <br /> EPA ID'. _qAP96139007_3. <br /> SIGNATURE OF AUTHORIZED AGENT : QUANTITY GAT YDS <br /> J,5" TO N t)' <br /> DISIGNATED FACILiTY: RYT.EASE 1 .262 2 <br /> DATE: _.GTBSCN .0 [J, �'.._-REFI17T1,11, C'o TN' <br /> ADDRESS : C(-!111iE.RC PiL DR17" :;' <br /> THE GENERATOR CERTIFIES THAT CITY , STATE Z IF*- A-K_E.-k Z_F1T:J,L)_.,_CA.___'4-1308 <br /> THE WASTE AS DESCRIBED PHONE:__80_5_/ 3,'7 _-(' �i3 <br /> IS 100% NON-HAZARDOUS EPA ID: '177 <br /> TRANSPORTER: TAG# : 03 04 <br /> UNIT NO. : <br /> ffAME! §TAMO@f INC, PICKUP DAT7 :_/_L- ,_ _TIME:�r�_ 'Z-_� <br /> ADDRESS : P.O. BOX 150 <br /> CITY , STATE,ZIP: SAN MARTIN , CA •95046 NOTE : THIS FOR! IS TO 7E USED TI; LIEU OF <br /> PHONE: 408/268-1196 THE CALIVORNIA Pi-PARTMENT OF HT'ALT1i <br /> EPA ID: CAD063547996 SERVICES HAZARDCUS WASTE MANIFI,ST <br /> SIGNATURE OF AUTHORIZED AGENT: POR T10N-H,',,.7ARDOU.1, WASTE ONLY . <br /> 1z -—---- <br /> DATE: <br /> THIS SECTION TO BE COMPLETED BY FACILI'l -1- <br /> DISPOSAL FACILITY : <br /> NAME: QUANTITY R <br /> ADDRESS : TOilS <br /> CITY , STATE,ZIP: <br /> PHONE: <br /> DISP . TICKET # <br /> SIGNATURE: <br /> DATE : S Fig T 'C"Uiln't1717 C <br /> JEl 0T <br /> RETURN COPY TO: j <br /> Rolls Lcf1FiT:, <br /> MUTE: I T IS N()I r."E C,'-- i"i <br /> ------------- <br />