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ttJ <br />U) <br />N <br />M <br />O <br />C) <br />Ix <br />Q <br />N <br />a <br />z <br />z <br />NON=HA ZARDOUS WASTE MANIFEST <br />Please print or type (Form designed for use on elito (12 pitch) typewriter) <br />NON -HAZARDOUS 1. Generators US EFA 1D No. Manifest ��� z. Page i <br />WASTE MANIFEST �'�°�'� DocumantNo. of <br />3 Generators Name and Mailing Address <br />Fart of Stockton <br />22011 ir1Jaf3hlrtgtan Ave. <br />Sinckkin,CA95261 }.J' ���C n yCry <br />4, Ganermot's Phone ( 2W9445 0246 X 25 f <br />S. Transporter t Company Name 6. US EPA 10 Number A. Stale Transporter's ID <br />hk;IRCHti C#tESml�i 7ranspactire. ($�ij CAR(i( 070540 B. Transporter t Phone �t18 }�-5t15f? <br />7. Transporter 2 Company Name 8. US EPA ID Number C. State Transporter's ID <br />D- Transporter 2 Phone <br />9. Designaled Faciery� Name and Site Address 10- US EPA ID Number E. State Facility's ID <br />wFa►waed k and rti CAL000190080 <br />quart S. AE a#n Road F. Facliftys Phone <br />m Pi rifulles, CA99336 <br />11, WASTE DESCRIPTION Containers t3- 14. <br />Total Unit <br />No. Type Quantity WLNoL <br />y NIM 1iY'�-�rt -%� =OUS WtTa7,i tt SOUD <br />00 ? CM >u� Y <br />NO <br />G b. <br />E <br />N <br />R C. <br />A <br />T <br />0- <br />R d. <br />G. Additional Descriptions for Materials Listed Above H. Handling Codes for Wastes Listed Above <br />�_ <br />- F'toject Number 65447 <br />i )ERGU;1 O393 Fjor-cam{ _ M <br />15. Special Handling Instructions and Additional Information <br />_OE <br />MV AW mr aw Am MIN <br />16. GENERATOR'S CERTIFICATION: I hareby certify that the contents of this shipment are full yy and accurately described and are In all respects <br />in proper condition for transport. The materials described on this manifest are not subject to federal hazardous waste regulations. <br />wz <br />4021 Date <br />Printed/Typed Name Signature Month Day Yea <br />T 17. Transporter 1 Acknowledgement of Receipt of Materials ..., Date <br />R <br />A PdntecUTyped Name Signature .. Y Month Day Year <br />P2,1 Z <br />O 18. Transporter 2 Acknowledgement of Receipt of Materials Date <br />R <br />T Pr nledliyped Name Signature Month Delay Year <br />E <br />R <br />F 19. Discrepancy Indication Space <br />A <br />C <br />120. Facility Owner or Operator. Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br />( Dale <br />T Printedrryped Name Signature Month Day Year <br />Y <br />CF14 02002 LABELMASrERO (800) 821-5808 www.labelmaster.com +f <br />