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s <br /> NON-HAZARDOUS WASTE PJANIFEST <br /> _- i-..m Jpsignad for use on eldo(12 pitch)typewriter) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Page 1 <br /> lei <br /> Document No WASTE MANIFEST of <br /> 3 Generators Name and Mailing Address <br /> N(1L: BV MST COUT D2CTS L= <br /> ARM 02093 P.D. RM 0245 <br /> 3425 TRZM BLVD RMEW ST MWMXTA, Cd 9V 88 <br /> itl 4 Generaors dne�& 9f A5-530=1530A ALT =' I== CMXX= <br /> 5 Transporter 1 Company Name 6 'US EPA ID Number A State Transporters ID <br /> Aall r <br /> Transporter)Phone _ <br /> 7 TWWI-ransporter 2 Company Name 6 US EPA ID Number C State Transporters ID <br /> D Transporter 2 Phone <br /> 9 Designated Factfrty Name and Site Address 10 US EPA ID Number E State Faalrty's ID <br /> X3373m, I=C <br /> LUS C Ar"InT JW F Faalrty's Phone <br /> yIIG VISTA, Cd MU , <br /> 11 WASTE DESCRIPTION 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity WWW <br /> D 19 � J J 6 <br /> G b <br /> E <br /> N <br /> E <br /> R c <br /> A <br /> T <br /> 0 <br /> H R d ,, <br /> G Additional Descriptions for Materials Listed Above H Handling Codes for Wastes Usled Above <br /> cc <br /> N 15 Special Handling Instruchons and Additional Information <br /> = boilwgilenc y Caatam (925)634-6850 DXLTJ RD <br /> Z M350 1-12I PW ALM 2003 4 <br /> Z <br /> AWAFAVAMAWAFAW-AWMAFAWAWAVAWMAWAV <br /> 16 GENERATORS CERTIFICATION I hereby certify that the contents of this shipment are fully and accurately de and are in all respects <br /> m proper condition for transport The materials descnUed on flus manifest are not subject to faders s wa to lations <br /> Date <br /> Pnntedr*edWjJLM P= MM _ Scgrratu -Mn <br /> RT 17 Transporter i Acknowledgement of Receipt of Materials Die <br /> A Pnnledrr Name Signature Month Day Year <br /> " W Irl � f3Z Q3 <br /> S <br /> P <br /> 0 16 Transporter 2 Acknowledgement of Receipt of Materials <br /> , Date <br /> ` T PnntedrTyped NameSignature . 1�1ontA Day Year <br /> R r� <br /> 19 Discrepancy Indication Space <br /> F - � u <br /> x <br /> 26 F It�r.Owner or Operator Certification of receipt of the waste matonals covered by this manifest except as noted to item 19 T <br /> L �cJ <br /> Date <br /> Pnnted/T rgnature 3 <br /> ypad Name S o ,Month s?Day Year <br /> CF14 02002 LARELAASMO(800)621-5808 wwwlabetmastercom n i, r w� ,t "®rwrrrnw�c�a[ar *� '�•�w <br />