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NWS HAY ROAD LANDFILL OUL%).L <br /> 6426 HAY ROAD <br /> VACAVILLE, CA 95687 <br /> PsgdryfTQ _ � ::; (707)678-4718 <br /> NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page Authorization No. <br /> WASTE MANIFEST NOT APPLICABLE Document No. of <br /> 3. Generators Name and Mailing Address M5_ N <br /> o��'n�nc>► " t3id�s, l7I V Comae►-rxf o .SAn ,moo �,�u I n '�/7� = <br /> 4. Generator's Phone( <br /> , 5. Tra porter 1 Compan me 6. US EPA ID Number Transp er's Phone <br /> �'� NOT APPLICABLE . 7�7 ��f�f 7 �� <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> NOT APPLICABLE <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> NWS HAY ROAD LANDFILL <br /> ` 6426 HAY ROAD C. Facility's Phone <br /> VACAVILLE, CA 95687 NOT APPLICABLE . (707) 678-4718 <br /> 13. 14 <br /> 11,Waste Shipping Name and Description 12. Containers Total Unit <br /> No. Type Quantity WWol <br /> f1� a. <br /> E b. <br /> N <br /> E <br /> c <br /> T <br /> 7 <br /> R <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 15.Special Handling Instructions and Additional Information <br /> j <br /> 16ENERATOR'S CERTIFICATtON: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Printedlryped Name Signatur Month Day year <br /> ,}os �PN f�Mhfr� Cons tq 3 2-9- 1 a.} <br /> 5 T 17.Transporter 1 Ackno dgement of Receipt of Materials <br /> R <br /> Printed/Typed Nam Signature Mordh D r i <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> lop- <br /> .13 Printed/Typed Name Signature Month Ray Year <br /> A 19.Discrepancy Indication Space <br /> C <br /> 4 <br /> ' I <br /> L 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> I <br /> T <br /> ' Y <br /> PrintedlTyped Name Signatur Month Day Year <br /> .. <br /> I <br /> ~' <br /> .wX�i w�;3 4 rr i as '�1t��t. t a `V ,;""`ik.."-1 <br /> l`tt3'-iw}��X'T ^ELr .rwr xZ�'".Afi Y-r` ;ed Thi aft;` t.� ���iw •n. h "' -tet <br /> ti " ORIGINAL—RETURN TO GENERATOR `' <br />