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• NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form decidetl for use on elita U 2 pit")typewriter) <br /> NON-HAZARDOUS 1.Gormcdor's US EPA ID No Manifest 2.Pagel <br /> WASTE MANIFEST 1 Document No. ja <br /> 3.General Name and Mailing Address #4Ltn)T3R06Y 4OLDIN6 LLC l( <br /> • 3135 g, (vi MN ST ftm <br /> ie,28b C�QAo1LSN's.2F p� , <br /> 4.Gentando,'s Pinata(CA 1 ) (,.t I,:; — , (I?" 5m(.mN( `4 1 <br /> 5.Transporter <br /> AI.Company Name 6. US EPA ID Number A.State TransponeYs ID <br /> \ DN ehi J` 1 R.Transporter 1 Phone <br /> 7.Transporter 2 Company Name e. US EPA ID Number G Slate Transporter's ID <br /> • D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.Slate Faolity's ID <br /> INSTRAT,INC. <br /> 110.5 C AIRPORT RD' F.FaNliys Phone <br /> RIO VISTA,CA 84571 (M)374.3834 <br /> I1.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> • No. Type Quantity WWOI. <br /> Vki <br /> l nog r �f j'7,�,ti7S <br /> G b. ; <br /> E <br /> N <br /> • E <br /> R o. <br /> A <br /> T <br /> O <br /> W <br /> R d. <br /> F <br /> In <br />•j G.Additional Descriptions for Materials Listed Aboye H.Handling Cortes for Wastes Listed Above <br /> N CaLOR- FROWN <br /> O <br /> r o 56uD— HNES <br />•a 15.Special Handling Instructions and Additional Information <br /> Z <br /> O <br /> Z <br /> IN IF AKAIL EAW-AW-AFAW-M <br /> 16.GENERATOR'S CERTIFICATION:I hereby ceniy that the contempt of this shipment are fully and accurately described and are In all respects <br /> in prepay condition for thamporit.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/typed No. SignatureMonth Day Year <br /> Ni ° 1.b r6 1 <br /> T 17.Transporter 1 Acknowledgement of Recelpt of Materials <br /> R Date <br /> A Pmflad9r7Na <br /> Iv Signature <br /> 5 n 1 /7Why, Day Year <br /> PC1(/o7 it- <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Date <br /> T PnnledrFyped Name Signature <br /> E Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I M.Facility Ownaror Operator.Cerlifiralion of reI Of Ne wase malenals covornd by this manifest,mrPApf as 1101130 in Bern 19. <br /> L <br /> I I F Dale <br /> TPrinleNfyped Name Signature ry <br /> //'��!!'�� M1SnIfI Day Vaar <br /> I <br /> L Mtcµ Q lJ>tl LIQ„J 161 lb 1 )3 <br /> F.t4®2002 LABELPIANI'MS (800)621-680a www.labelmaslercom <br /> n1N Rev.3^J6 <br />