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WHITE—ORIGINAL (Return to Generator) YELLOW—TSOF (Retain Copy) PINK—TRANSPORTER COPY GOLDENROD -GENERATOR'S COPY <br />NON -HAZARDOUS 1. Generators US EPA ID No. <br />2. Pape 1 <br />3. Document Number <br />WASTE MANIFEST <br />of <br />� <br />LU 00 <br />4. Generators Name and Mallinp Address Neenah aper <br />942 South Stockton Ave. <br />Ripon, CA 95366 <br />209-968-2539 <br />Generator's Phone <br />S. Transporter Company Name 8. US EPA ID Number <br />7. Transporter Plane <br />CLEARWATER ENVIRONMENTAL CAR000007013 <br />510 476-1740 <br />8. Designated Facility Name and Site Address 9. US EPA ID Number <br />10. Facility's Phone <br />sum q- <br />six_ u r 11340 <br />G <br />E <br />N <br />11. Waste Shipping Name and Description <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />E <br />No. T <br />Quan' <br />WUVoI <br />R <br />A <br />a. <br />Non -Hazardous waste <br />®� 1 <br />1 <br />T <br />0 <br />R <br />b. <br />15. Special Handling Instructions and Additional information <br />Handllnp Codes for Wastes Listed Above <br />Wear PPE <br />Ila. 1 t b. <br />Emergency Contact <br />(510) 476-1740 <br />Attn: Charles Seaton <br />18. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to state or federal regulations for reporting proper disposal of Hazardous Waste. <br />T <br />Ponted/iyped Name <br />Signature <br />RMonth <br />A <br />�Lk.V_; �W 5 <br />Day Year <br />t <br />P <br />17. Transporter Acknowledgement of Receipt of Materials <br />0 <br />R <br />Print N <br />Signature <br />440,707Dey Year <br />E <br />� <br />i0 <br />IO <br />R <br />l <br />18. Discrepancy Ind tln Space / <br />F <br />A <br />C <br />I <br />L <br />I <br />T <br />Y <br />19. Facility Owner or Operator. Certification of receipt of waste materials covered by this mardeat 8Xcqpl as noted in Item 18. <br />Prinledi"yped Name <br />Signature <br />Nries csm{ <br />Month Day Year <br />b 13 to <br />WHITE—ORIGINAL (Return to Generator) YELLOW—TSOF (Retain Copy) PINK—TRANSPORTER COPY GOLDENROD -GENERATOR'S COPY <br />