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Y <br /> N <br /> AZARDOUS WASTE MANN <br /> Please print or ' (Form designed for use on elite(12 pitch)typewriter) <br /> 1.Generator's US EPA ID No. Manifest - 2.Page 1` <br /> NON-HAZARDOUS ` DocumentNo. of <br /> WASTE MANIFEST C l 932. 508 25� ,r �3g31 <br /> 3.Generators Name and Mailing Address <br /> .iriifie.3 4astarn Crccers-Itta. ; ''at Guider-t-tY- <br /> 5200 Sar t, GJ ,1ierce, CN. 9104-0 <br /> 4.Generators Phone( 323) -'2-64-520-9 <br /> 5.Transporter 1 Company Name - - 6- US EPAZD Number A.Siate Transporter's ID <br /> :� ma ,-y�a,s T C.-IT nB.Transporter 1 Phone <br /> 7.Transporter.2 Company Name fi. US EPA ID Number C.State Transporte?S ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID ' <br /> Re"LOY aqviniollnental <br /> 2000 .P-Br='.mla je ;.fin$ z F.Facility's Phone <br /> - .,w s iaL. C1. 933'37 ,� CIL 000 220'- 39, . 531-&37-1852 <br /> 11.WASTE DESCRIPTION 12. Containers 13: 14. <br /> Total Unit <br /> No. Type Quantity WtNol. <br /> a. f <br /> LT'Lnos " s, f7 r <br /> 1 <br /> G b <br /> E <br /> i E ' <br /> R c. <br /> A - -I <br /> O . <br /> W R d. <br /> a G.Additional Descriptions for Materials Listed Above - H.Handling Codes for Wastes Listed Above <br /> 00 ARD- 104-TV-01-059 <br /> I Q <br /> a <br /> N 15.Special HandlingInstructions and Additional Information 1- -: Facility <br /> M1t <br /> Jn�,:Si_*�:- �Stoc''.�ar� _acili� <br /> Acwli R,14 <br /> 5'toc,*t0n, CA. 95215 <br /> 0 <br /> Z . 5909-53.39-5607 <br /> t 16.GENERATOR'S CERTIFICATION:I herebycertify that the contents of this shipment are fully and accurately described and are in all respects <br /> 14 in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Typed NameSignature ,,1 Month +/DYay ./Year <br /> h;n 1 �r -. : : <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials Date. <br />{ N Pri t d/Jy <br /> ypad Name Signat�tr f ' Month Da�f. Year <br /> U18.Transporter 2 Acknowledgement of Recelpt of Materials - - - Date . <br /> TPdnte&Typed Name Signature Month Day Year <br /> i R <br /> 19.Discrepancy Indicatlon Space <br />} 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this mahlfest;except as noted in.item 19. - - <br /># 1 Date <br /> T Printed/Typed Name Signature Month Day--Year s ,, <br /> -F-1402002 UWLAASTER0(800)621-6808 www,taWmaster.com r�� � � . . ' Rev.3195 . <br /> PqurTEp ON��pFO PAPEq lC�.J r�i�rro vnrx <br />