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„71 r-_3 '?; <br /> p n _ <br /> de e f ar. <br /> 1. Generator's US EPA ID No. Manifest 2. Page 1 <br /> NON-HAZARDOUS ❑ocu eat No. <br /> WASTE MANIFEST . • • . 1 of 1 <br /> 3. Generator's Name and Mailing Address <br /> i ew Q,zc: 'iiL.'.S ti. <br /> 1431 Atteberry Lana <br /> 4. Generator's Phone <br /> c ) gun jose, CA 95'131 800-745-;4c9 <br /> ti <br /> 5. Transporter 1 Company Name 6- US EPA ID Number <br /> C yeti tlatcr Zal Ssry ce . . . . . <br /> 7. Transporter 2 Company Name 8, US EPA ID Number <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number A. Transporters Phone <br /> =G Y ,. `� ✓. B. Transporter's Phone <br /> .C- }} ✓:�-_�r�ss w ;J G C. Facility's P one 1£ <br /> Q 7 C' .�•� I '�.1� �1' ifT `' �1— <br /> 1 '✓12. Containers 13, 14. <br /> 11. Waste Shipping Name and Description TataI Unit <br /> No. Type Quanti Wt Vol <br /> G b- <br /> E <br /> N <br /> E <br /> R <br /> A c. <br /> T <br /> O <br /> R <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 15. Special Handling Instructions and Additional Information } <br /> 16.GENERATOR'S CERTIFICATION: I certify the moterials described above on this marwfest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Printed/Typed Norryg-- Signgfjure Monlh Day Year <br /> T. <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R �' Month Da Year <br /> A P'nted Typed Name f Vr — �� ^ x, r <br /> "s <br /> P <br /> 0 16.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name - Signature _ Mo,th Day Yeo, <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20,Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> T <br /> Y <br /> Printed/Typed Name Si nature ., _ Month Day Year <br /> TRANSPORTER #1 <br />