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` NONmHAZARDO'US WASTE MANIFEST <br />Please print or type (Farm designed for use on elfte (12 prieh) typawi teri <br />' :NON-HAZARDOUS 1. Genefat6es US EPA ID No, Manifest 2. page 1 <br />WASTE MANIFEST CAT. KX)041551 DOCAte o No. T3165953 of . <br />Pont of tor�and Mailing Address <br />2201 " 02- bn hm0 <br />a, aarwaturs Phone ( 299"6014005 <br />S. Transporter 1 C«u'+Peny Nanta B. US EPA ID Nwnber A. State Transporters ID <br />mWmachef rt1n�11 poft info (4tVj CARt�pt}b7tlS U B, Transpadarl Phrnie 408-5 -3050 <br />7.Tran6poder 2 Company N" a. US EPA ID Number Cr State Transporters ID <br />D. Transporter 2 Phone <br />9. Designated Facility Nance and Site Address 10. US EPA ID Nurnber E. State FocWs ID ' <br />AhAmcod Chlomlew 7h"w4mit, kkm (mcd) CL L00033"54 <br />�.� �iIR F. FadBty's Phone <br />r 95341 209422-4221! <br />11. wASTE DESCRpnoN Contain" 130 Tote) troll. <br />_ No. Type Otmoty WtNol. <br />Nlqtdd <br />rx <br />E. <br />y.> <br />'N <br />R' <br />•A`_ <br />R. d: <br />.:, fl. Addldonal D"c{Iptbrw iot.hfale+lels Limed Above. H. HandhV Codes lar Weetea UAsd'Above ..; .. <br />4 < i pro} Nutmbw 57 <br />1 Off' A(W r% <br />0: <br />16. Special Handing Indtnictiorm and Additional In(omu Wan <br />z" {� J <br />o. <br />z W AV AIV AV AM AV AV ARW--AW-mi year <br />---- - -W <br />"7&.DEH R s car* that the contents of die shoneM tae fu[ly mid aczurataly deecdbed and are in aA respects � <br />in a deacrihed on thla manifest are not subject to rodent twxardowt waste repuf Wns, <br />'!.1 :1 S{prtalure <br />Day � YeAt: <br />h <br />A' 17. Tmriaporter 1.Adm*wledpement of Recelpt of Maleiials DateAkmh <br />A PdMad/Typed Name ' "Slanehxe " Uay . ` <br />P 13. Transpodet 2 Admowledgr mwd of Receipt Mat <br />tura <br />op a :Dale <br />T, PdaiedrfypaiName SlQns ,Ncitth'; Glay '. Year . <br />10. Dlscrepertcy lnftaWn Space <br />F <br />A <br />C' <br />1. 20. Facft Owner or Operator. Cattifleatbn of receipt of the waste materiels covered by We menlfast, except as noted In Ilam 19. <br />T PrlMad/Typed Nemo Slpnattxe AW& rwy year <br />Y <br />CF14 02002 <br />I.ASEtMnsTr�t• (80D)821 -58D8 www.tabetma9tar.com @���"� <br />