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1.Customer US EPA ID Na Manifest 2.Page 1 <br /> BILL OF LADING 3 8 <br /> Document No. of <br /> 3.Generators Name and Mailing Address <br /> r, fARD REMOVAL <br /> 63'il E:. JOINL'S'TAT} <br /> a fi3erter�toris�fwne( >)� . <br /> CA '45320 <br /> 5.Transporter 1 Company Name & US EPA ID Number A.State Transporter's ID <br /> <31 l4 t h r r g3 ,s•r. (1 j s{ " t;,,, S.Transporter 1 Phone { (!�#7 7 <br /> iS fTcL J�::a4.i+PS.a t;..� 4 1-1 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2Phone <br /> 9 Designated Facility Name and Ske Address 10. US EPA ID Number E.State Faciiitys ID <br /> 1737 [iEN w T REE T F.Facillty's Phone <br /> C;A 90744 q,A V 0 Q_g <br /> 1 t.WASTE DESCRIPTION 12.gontainero 1 a. <br /> Tot <br /> al Unit <br /> NO. Type Quantity Wt./Vol. <br /> srt Via, 1 1, It SU"l.'+#dl!/EtZSAL WASTE" <br /> b. <br /> C. <br /> Z d. <br /> 0 <br /> G.Additional Descriptions for Materials listed Above H.Handling Codes for Wastes Usted Above <br /> LL <br /> O <br /> J_ <br /> m <br /> 15.Special Handling Instructions and Additional Information <br /> ?v4chr: 4.,hg,V t,). '1 000-424-937{0 PROFILE 991 CPE14l <br /> 1"�i',6f ��CLE E(��s? ���E 1V l <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materiels described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Typed Name Signature M90th :Day" <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> APrinted/Typed Name Signature Month Day Year <br /> N <br /> S <br /> P Date <br /> p 16.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed ted/Typed Name <br /> Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> L20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> I Date <br /> T PrintedrTyped Name Signature Month Day Year <br /> Y <br />