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NON-HAZARDOUS WASTE NON-HAZARD US WASTE MANIFEST <br />..____.. <br />NON-HAZARDOUS <br />WASTE MANIFEST <br />1. Generators US EPA ID No. <br />CAL000368693 <br />Manifest <br />Document No. <br />2 7 4 3 2 <br />2. Page 1 <br />of I. <br />I I 3. Generator's Name and Mailing Address <br />IMPERIAL TRUCK AND WASH REPAIR <br />21.42 W YOSEMITE AVE <br />MANTECA CA 95337 Generators Phone ( 209 239_8111 <br />Transporter 1 Company Name 6. US EPA ID Number A. State Transporters ID <br />I B. Transporter 1 Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number C. State Transporters ID <br />I D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />YOLO COUNTY CENTRAL LF <br />°I <br />E. State Facility's ID <br />44090 ROAD 2SH <br />WOODLAND CA 95776 I C,U 000079SS7 <br />F. Facility's Phone <br />5SO SeS-8852 <br />I 11. WASTE DESCRIPTION 12. Containers <br />No. Type <br />13. <br />Total <br />Quantity <br />14. <br />Unit <br />Wt/Vol. <br />I a.., <br />NON-HAZARDOUS WASTE, LtQUID "SUMP WASTER <br /> <br /> I --irr iCAL4'.15' <br />G <br />E <br />N <br />E <br />b <br />R <br />A <br />T <br />0 <br />c <br />R di <br />I 1 G. Additional Descriptions for Materials Listed Above <br />I , 1 <br />H. Handling Codes for Wastes Listed Above <br />PO <br />15. Special Handling Instructions and Additional Information <br />EMI=F;3PNCY CONTACT : CHEMTRPC 1-8C30-494-9300WCPS TERMKAI •:Di.),:on *PROFILF # 9E1 : 2021-3n *APPROPRIAT,P - ,--- PERSONAL PROTECTIVE EQUIPMENT ,---- <br />:..---,., -,...:,>;.4::,,,, <br />, • <br />..r. r-....i.1.1.v? SITE-: ')147 V OirTP AV , liTiiiii <br />Aff Difitilfialt 11/1111/N/M. *IF <br />GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment are fully endadctiratelydescribed and are in all respects <br />in proper condition for transport The materials described on this manifest are not subject to federal and state i-P,r-rdous waste regulations. <br />I i I Date <br />1 <br />Printed/Typed Name <br />7 <br /> ,_).- m.p4,-iwr StA VAAL <br />I Signature Month Day Year <br />,.., .., . .,,,,-,,f-_,-, 1 <br />T Transporter 1 Acknowledgement of Reoef4i.(100tatenals Date <br />R <br />A Printed/Typed Name -..:::___ <br />I Sigyr.--; v'z' Month Day Year , <br />P 0 s, <br />. 1 8. Transporter 2 Acknowledgement of Receipt Of Matenals <br />4_.._ <br />Date <br />T <br />E <br />R <br />R Printed/Typed Name Signature Month Day Year <br />I I <br />F <br />A <br />C <br />Discrepancy Indication Space <br />I Facility Owner or Operator: Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br />L <br />I <br />Date <br />T <br />Y <br />Printed/Typed Name Signature Month Day Year <br />I I