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r <br />NON -HAZARDOUS WASTE MANIFEST <br />Please pdnl or type (Form designed for use on eft (12 pitch) typewrkat) <br />NON -HAZARDOUS 1. Gonerator's US EPA ID No, Manifest 2.:Page I <br />WASTE MANIFEST CA41551 Document No, <br />Td�saw D561 of al <br />_ 3. Generators Nome and MWAQ Address <br />of n' <br />�� 1 V1fi�hbtttkin /het. --- . <br />CA852Q'1 +�,� <br />:4, Generator's Phone ( 2/�qs" W6 X 25% <br />''B. Treitapartar 1 Company Name 6 US EPA ID Number A, State Transporteea 10 <br />fif2W!!l13d C h ilad T lArind he. (AM CARtr"" 030 assBaTrerporterall Phone <br />7. Transporter 2 Company Name so US EPA 10 Number Co State Tmnsporter's ID <br />D. Transporter Phone <br />B, Designated Facility Name and Site Addroae IGO US EPA ID Number E. State Facillity's ID <br />FWNwd L.andU CAU001 t0 <br />mmo-O ,Main R,M F. FadlNy's Phone <br />McMettat CAN5335 <br />I I a WASTE DESCRIPTION Containers 133144, <br />TOW Unk <br />�y�`�xT +j]' yy.���'�[� '(xt'l �+/�i �ry No. Type ouantity NR.Noi: <br />��-- d4! �, J � Y <br />G b / <br />E <br />E Itv <br />A Cr <br />7 <br />O d <br />R <br />W <br />a. <br />E" G. Additional Oesafp Ions for MaterlNe la Above'`. ' - }I. Handing codes for wastes Usted Above <br />QPira)ed Nwnb&r 4MB <br />N pm <br />...l I)ERGW; Of 0M POF4,4t0 <br />o <br />' ISO' Specht Hanfiv Instructions and AdOlonal Information <br />a - . <br />z <br />maw <br />z .AM., Air Alf <br />try fully 16, N � tMdOW�tre ap The rnalerlafe�ddesmfl tdoon contents <br />ffmffN� areata shipment <br />tc federal wasteett nst all respects <br />Date <br />ENO <br />Prkttedliyped Name Signature 'Month Day Year. <br />T. ` 17. T4#0&W— 7 AcWwwledgemem of Receipt of Malettala <br />p r <br />PlMscitrypea <br />d Name SkJ <br />N Month Day Yew <br />F.A V14661-:1 <br />Inca <br />iB. Tranaponer 2 AckrwwNdpemetrl Heptpt of Matertab ; Date <br />' fhlnto&Typed Nam Month Day Year <br />t9. Dtecraperxy Indlcation Space <br />F <br />A <br />C <br />20. Fac" owner or operator. Codification of receipt of the waste materials covered by fhb rnantiest, except as noted M item 19. <br />L Dela <br />T Pnnted/T yped Name Signature Month Day ' Year <br />Y <br />CF14 O 2002 t.ARELMAsTE0 (900) 821-5BOB www.lahelmaster.00m <br />r I <br />