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NON-HAZARDOUS 1. Generators US EPA ID No. Manifest 2. Page 1 <br /> WASTE MANIFEST _ Document No. of <br /> 3. Generators Name and Mailing Address <br /> WAL-MART #1554 - STOCKTON <br /> 32223 TEAST HAMMER LANE <br /> 4�Caen.Qrr pho e� 9521?� <br /> 209 '73-2796 <br /> S. Transporter 1 Company Name 6. US EPA ID Number A. Transporters Phone <br /> (909)598-4449 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporters Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> LAKELAND PROCESSING COMPANY <br /> 12345 LAKELAND RD. <br /> -, 567_) 944-6111 <br /> SANTA FF SPINGS, CA 11. Waste Shipping Name and Description 12. Container Total Unit <br /> No. Type Quantity Wt Vol <br /> a• NON HAZARDOUS WASTE LIQUID (CLARIFIER) <br /> 7 <br /> T.: 0'() G <br /> p b. <br /> E <br /> E <br /> R <br /> A c. <br /> T <br /> O <br /> R <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> a) Clarifier <br /> 15. Special Handling Instructions and Additional Information <br /> WEAR APPROPRIATE PROTECTIVE GEAR. 24 HOUR PHONE (909) 598--4449 <br /> CLIENT: WAL-MART 01554 <br /> BILL TO: ISLAND ENVIRONMENTAL <br /> W.O. #054844 <br /> 16.GENRRATOR'S CIRTINCATION: I certify the materials described above on this manifest are not subject to federal repuiatlons for reporting proper disposal of Hazardous Wase. <br /> Primed/Typed Name...., i i Sig r%' ; "I j' 11. Day Yea . <br /> tfr t t i . t !, / �(!L. 1o:'�.. U <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials i <br /> 11 Printed/Typed Name ! ' Signature, -, 'J Mon y Your <br /> F <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> 1 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Mem 19. <br /> t <br /> Y Printed/Typed Name Signature Month Day Year <br /> GENERATOR'S COPY <br />