Laserfiche WebLink
----------------------------------- <br /> NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS f`A(�OOObAZ3i36 MDoaaumbandNo. �}17�1l1 erg° 9 <br /> WASTE MANIFEST <br /> E3.Ger�sl�rnfsnNgaMe aritl Matins Atltlss <br /> re <br /> 1.Q.AkpW SWdft%CA9520fi,CAg5M - <br /> 4.Generators Phone( 2PS�-94&V72 <br /> .Tmnsp 1�,.._pant/di@.___Md��seq 16 US EPA ek"wo as A Trate TranepoMontee.ID _ - <br /> l:Il�lllll81 flHriSY.^. "/ V.Yna B.Transporter Mona <br /> 7.Trarwp°rtar2Company Name a. US EPA ID Number C.SM Transporters ID <br /> 0.Tranapader2 Phone <br /> B.Dee' F}ctlib Namg ppd Site Atls�'�) 10. US EPA ID Number E.State Faalitys Iq,__003,3645 <br /> 65 Riggs AM f fa F.Facifnys Phona �209-722-4228 <br /> J <br /> MNceG r CA0GU1 <br /> 11.WASTE DESCRIPTION Conbineta 1c3. 14. <br /> UnF <br /> ������rp������� �1t� /� aa� DM <br /> No. Type Ouanuy WLfv'ol. <br /> NON N11ARDOUS WASTE UQUm(ACT268� <br /> G b. <br /> E <br /> N <br /> E <br /> R ° <br /> A <br /> T <br /> 0 <br /> R d. <br /> W <br /> NG.Adddlonal Descriptions for Matenals Usted Above H.Handling Codes for Ward.Listed Above <br /> 3 ProjectNumbw 16227. <br /> N )ERt3p;ig867ocAEAA-1:1 ( 'ac-�- �Z�-3f7 " <br /> 7 <br /> O <br /> 0 <br /> 15.Special HeMilm,1 Inatmribns ark Additknai Intomtation <br /> a <br /> N <br /> 4 <br /> S <br /> Z I <br /> O <br /> z <br /> GENERATOR'S CERTIFlCATION: herebbyy cedity tlq[Ste contents of tNs sM1ipmantere iWlyy and acanately deacnbed ark are In ell reapeete <br /> 16. <br /> b propercwkidon forvanapod.The mmarlals des boat °n bb manifest ere rwt subject k lederal hazardous waste i°guladons. <br /> Dab <br /> Pr'uded? Name SlgnaW MartM Day Year, . <br /> T 17.Tralreporter,1 Aclmowbdgemant of Receipt of Materials A <br /> Deb <br /> A Printedrfypad Nen» Signebre 7m my Year <br /> IN 1 <br /> P Dab <br /> 0 10.TMnsporter2 mviedgamantd Dat Materiels <br /> E PrinbtlRyped Name Slgnma, L Monty DeY Year <br /> L /a <br /> R <br /> F 19.Di5crapencyindreallon Spare p�(, <br /> A <br /> C <br /> L 20.FadIXy Owner ar Oparefor.Certgiceson of receipt of rile waste material mvared by this arenMest,except as noted k gem 19. <br /> Dere <br /> T Pdnted?ypetl Name Si9rlaWr 140db EASY Yeer <br /> Y (1 <br /> CF14 02002 L LAAO QD (800)821-5808 www.labelmaster.com ® -"--'-- I - <br />