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HAZARDOUS WASTE •MANN- L-.� ' . <br /> Please print or We (Form designed for use on elite(12 pitch)Eypewriter) - - <br /> NON-HAZARDOUSifest <br /> 1.Generator s US EPA ID No. Document No. 72.Page t <br /> WASTE MANIFEST CND 982 50 3 251 5 4086of 1 <br /> 3.Generator's Name and Mailing Address <br /> Jmf isl astera Grocers-Atn: Paw. Gailler-nety <br /> 5200 Saeila Street, CaMmarco, Cx. 90640 " <br /> 4.Generator's Phone( 323) 264-5200 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number ' A.State Transporters ID <br /> Aaz �t Trans, Inc. w`.9$� 012 �3Q0 8.Transporter 1 Phone 909-889-5607 <br /> 7.Transporter 2 Company Name 6. - US EPA IO Number- C.State Transporter's ID - <br /> .D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address` - -.14. US EPA ID Number - - E.State Facility's 1D <br /> Raine dy-a3ViZ07lt17p._T]a I <br /> 000 E. T3r;]j ia4ri <br /> e Fap. F.Facility's Phone <br /> Ha::tersfield, Ca. 93307 CW;000 220 39, i 661 '637-1852'' <br /> 12. Containers 13. : 14. <br /> 11,WASTE DESCRIPTION Total Unit <br /> No. Type Quantity WtJVol. <br /> a. i <br /> ' .. v - 1 � T 7CC�� G .� <br /> MN--i-AMM:]S WASTE LI RIDS <br /> G b <br /> N . <br /> R c- <br /> LU <br /> CD <br /> G.Additional Descriptions for Materials Listed Above - <br /> H.Handling Codes for Wastes Listed Above <br /> cn a.) noi-ia.zar3ous.grater <br /> Q 2ROFTLEV, <br /> . 107--TITT-10-0409 ' <br /> a: . ons and Additional Information' - ,Jo] Site: -S t-od&,on-'Facility 15Special Handling Instructi -. <br /> 1990 9iccoli R3. <br /> Z GLOVES & G�7CIGME"s stod-,ton, �CA. 95215 , <br /> Q <br /> Z �z�y. u909-889-5607 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of.this shipment are fullyy and accurately described and are in all respects <br /> iri proper condition for transport.The materials described on this manifest are not subject 10 federal hazardous waste regulations. - <br /> - <br /> F - <br /> Printed/Typed Nam - Signature Month' Day Year <br /> e f 2r- <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials - - - Date ' <br /> NPrint d Name - '" -- Sign r - Month Day Year - <br /> 16.Transporter 2 Acknowledgement of Receipt of Materials - Date <br /> T - - Si nature - - Month Day Year ' <br /> Printedrryped Name g <br /> E <br /> iR <br /> 19.Discrepancy Indication Space <br /> F <br /> C <br /> .. in item 19. - <br /> this mariifast exce t as noted - - <br /> waste materials covered b P <br /> Operator.Certification of receipt of the as y <br /> 20.Facility Owner or Opera p - - _ <br /> f' L Data, <br /> T Printedrryped Name Signature: Month Day Year <br /> I <br /> F-1402002 . LABELAAsm taw)r,21 www.labelmaster.com /,i,+fPaVMDONREClCLEDPAPEa rm.,eow,�. Rev.3195 , <br /> 11UMMYSEANNK SlW IM1r <br />