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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> Manifest <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Document No. 9 1) 9 (1 2 2.Page 1 <br /> WASTE MANIFEST °' <br /> 3.JftoI'S7�PP� dnd Mailing Address Pa Bo 90 <br /> 87 <br /> IL617 REST FREWNT STREET IAS AgGELES, CA 90009 <br /> STOCMN, CA ATrR: PAUL SUPPLE <br /> 4.GeneratodsPhone —� '� <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's tD <br /> DILLRRD EMROHMENTAL SVCS- C .E D 9 8 2 5 2 3 4 3 <br /> B-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.imMi i)d�ft Address 10. US EPA ID Number E.State Facility's ID <br /> 10840 ALTAMRT PASS ROAD <br /> LIVEIRMRE, CA 94550 F.Facility's Phone <br /> L A U 9 8 1 3 0 2 7 3 2 (925)449.6349 <br /> to r. <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Tota! Unit <br /> No. Type Quanlity Wt.Nol. <br /> 55095600) <br /> b D Y�Y 49 0 P <br /> G b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> R d. <br /> a <br /> r� G.Ad <br /> ditional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> N Lt 11b. <br /> 0 3101_ <br /> Q �ti <br /> Q i <br /> Q15CRig: glWi*IrL%oniacrVAddit"MrJT4T68S0 DILLARD <br /> _ mit lam-o11 PO6 09-3316a <br /> Z <br /> 0 <br /> ZT <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment&anarcurDteIyd.scnf,,d and tri all pests <br /> in proper condition for transport.The materials described an this maniiesl are not subjus wasDate <br /> Pr�f1fER ARCA Month Day Year <br /> T4 17.Transporter Acknowledgement of Receipt of Materials X, Date <br /> A Prin!ecIfTypatame SignatureMonth Day Year <br /> N i k 0 0 p <br /> 0 is.,Trans er 2 Acknowledgemen! Receipt of Materials i Date <br /> TPrin yped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20-Facility Owner or O o ertification ipt of the waste materials covered by this manifest,except as noted in item 19. <br /> Date <br /> T Printedrfyped NameSignature Month Day Yaar <br /> �MRFDOIi 9CC°0.EDryrrN <br /> CF14 LAULAASTEt6(800)Wl-60W w WmwwW- m SD"' Awl Q <br />