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NON-HAZARDOUS <br />2. Page 1 <br />of <br />75 45 <br />1. Gen erat or's US EPA ID No <br />Manifest <br />P o�,um�nt No. <br />WASTE MANIFEST <br />- - - <br />generator's Name and Mailing Address <br />JN",0,N PACIFIC RALR(AD <br />. H 3T. <br />E. 911, ` <br />S­,TC,1,(.'KTCN (,,A 96206 <br />4. Generator's Phone ( 9 1 f� <br />5. Transporter 1 Company Name <br />6. US EPA ID Number <br />A. Transporter's Phone <br />G' A D 0 '1' 2 9 6 :� -7 <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />. . . . . . . . . . <br />B. Transporter's Phone <br />9. Designated Facility Name and Site Addre: s <br />10- US EPA ID Number <br />C. Facility's Phone <br />.1.) ' I I F EC"Y* <br />i NIMER""'A' FILTER R <br />U N G <br />2N-Elf) E 15TH STIREET <br />92"', <br />11. Waste Shipping Name and Description <br />12. Containers <br />13 <br />Total <br />14. <br />Unit <br />No. Type <br />Quantity <br />Wt/VOI <br />a. INON HAZARDOW V%, .ATE <br />D UO <br />C <br />ff.*,,r',AiNE-','.',!JSF.'-,- UL FILTER <br />R,ECYCLNG�), <br />CO./ <br />b. <br />C. <br />d. <br />D. Additional Descriptions for Materials List <br />d Above <br />E. Handling Codes for Wastes Listed Above <br />7i <br />REC­ f V­, <br />4 <br />15. Special Handling Instructions and Additi�onai <br />information <br />RGENCY tit'! <br />Y�, J 1 P14 <br />4 6, 9:3 2 6 WEAR ?Lppp%(j , <br />,F. EVT <br />16. GENERATOR'S CERTIFICATION: I cert <br />the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br />Printed/Typed Name <br />Signa <br />Month Day Year <br />t0V <br />• <br />'Own <br />r <br />1 17. Transporter 1 A(.knowledgemtnl it he_c.ipt <br />of Materials <br />k <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />I b -21( <br />18. Transporter 2 Acknowledgement of Re <br />c ?ipt of Materials <br />Prinied/Typed Name <br />Signature <br />Month Day Year <br />19. Discrepancy Indication Space <br />F <br />C <br />L 20. Facility Owner or Operator: Certificate <br />of receipt or waste materials covered by this manifest as noted in Item 19. <br />T <br />Y Printed/Typed Name <br />Signature <br />Month Day Year <br />GENERATOR'S COPY <br />