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PROFILE NO. It — <br /> NON - HAZARDOUS WASTE MANIFEST i\. 29273 <br /> 7T NOTE: <br /> O <br /> IVwwMi/'.iNNN/rNtirv.v/WWyIJ,yyyNNNNNN.y•y•.,tNNNyI•MIN•yyylVlWy'yivry..dNN/.//vN..NVNNNN�M/NNNI/NNN <br /> E Name: LLC- <br /> C Address: � �• IA14t.Jah 12 <br /> O <br /> M City/State/Zip: L06I Cq <br /> P q <br /> L Phone No. 2v�p I :56 r 104 ' Contact: <br /> E <br /> T THE GENERATOR CERTIFIES THAT Signature and date of authorized agent: <br /> E THE WASTE AS DESCRIBED IS 100% <br /> D NON-HAZARDOUS 09 /6 <br /> B Waste Description : <br /> Y <br /> Generating Location: <br /> -- G Fp <br /> E Handling Instructions: <br /> N n <br /> E Quantity: BBL GLS 1� 41)S TONS <br /> RJJJ <br /> A CONTAINER TYPE : <br /> T <br /> 0 a TANK TRUCK DUMP TRUCK DRUMS BINS OTHER <br /> R 11 <br /> A O 6940 Tremont Road <br /> G <br /> E ,�,�p LLO, Dixon,CA 95620 <br /> T10�3 W,.•' , Phone Fax(09) 274-6598 6 <br /> T Name: J yQil LL6 TICKET# �7 17 TRACT/TRLR# 4 Ty <br /> R <br /> A <br /> s 0 T 'O�l �A Bin No's �7 601 <br /> Address <br /> P <br /> O <br /> RCity/State/ZZp:Dl7C� �� Signature: <br /> T <br /> E <br /> R Phone# 20 /Q <br /> / 279 Date: 09 16 121 P/U Date: c 2 / <br /> DESIGNATED FACILITY: <br /> T ff__ �t� L�)2 6 � R \ <br /> S Name: 7ftO� nl ���'}t( � Address: U c <br /> DCg °15- 7 'o7 <br /> City/StCity/State/Zip: �1CavI 0Phone <br /> F Discrepancy: <br /> A <br /> C DISDOS8I Method: <br /> I <br /> L Landfill Other Time: am/pm <br /> I <br /> T <br /> Y Signature : _ Date: / / 2 <br /> White•Generator Retain Yellow-Transporter Retain Pink-Facility Retain Gold-Agent Retain <br />