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N�AZARDOUS WASTE MANN <br /> Please print or type- (Form designed for use on elite(12 pitch}typewriter} - <br /> 1:61nerator's US EPA ID No. - - Documefestnt <br /> - 2.Page 1 <br /> NON-HAZARDOUS. : Documenwo. 01 <br /> X03 257 <br /> WASTE MANIFEST C. .982. <br /> 3.Generator's Name and Mailing Address ^ <br /> 7ri1.fii�,..1 :destera Ctocnrs - "�j: Da , Csijllsre y. <br /> 5200 Sleila Strwtr .' a r '., CN. 4 040 . <br /> 4.Generator's Phone( 32.3) 264-5200 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number �1n A.State Transporters 10 - - <br /> - {'$ c-1i s� .J C V '3�� J�� 800 �:B.Transporter 1 Phone � - . <br /> 7.Transporter2 Company Name 8. . US EPA_ID Number C.State Transporter'$ID ' <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA 10 Number '- E.State Facility's ID , <br /> zamxely <br /> 3200 �� L �C.E;ra - F.FaciliVs Phone <br /> f ��aaisn, ax. 92306 <br /> CyL 0!�0 200 TOO: 714-1530-2.307, <br /> t4. <br /> 11.WASTE DESCRIPTION 12. Containers_ Total 'Unit <br /> No. Type Quantity wtNol. <br /> a. <br /> •a' STE' L-1 PITY3, <br /> i <br /> G b. <br /> 4 R c. <br /> T <br /> W d. <br /> Q - G.Additional Descriptions for Materials Listed Above. _ H.handling Codes for Wastes Listed Above - <br /> l <br /> N a.1. 1'}0 x1-'A zarj0'as watar <br /> OA ? J Ls #04--WM1-099 <br /> N 15,Special Handling Instructions and Additional Information JoV Site: S?~Cd,{ton Fact- �Vy <br />! _ 1990'?jccoLj R,i. <br /> C1 95215 <br /> Z 1909-9 9. 5607 <br /> AIV <br /> i <br /> GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and axurately described and are in.all respects <br /> in proper condillon for transport.The materials describedonthis manifest are not subject to,lederal hazardous waste regulations. 1 <br /> Date <br /> Printed/TypedNam _ Signature-.-----, -� [' - - Month Day Year <br /> 771 <br /> Transporter 1 Acknowledgement of Receipt of Materials _ _ - - Date- <br /> R - �' <br /> N 0Z 1 Z7167 <br /> Print a Mo <br /> yp d Name Signet nth Day Year <br /> PO 18.Transporter 2 Acknowledgement of Receipt of Materials _ - Date <br /> T <br /> Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> r F <br /> t C <br /> 20,Facility Owner or Operator;Certification of receipt of the waste materiats covered by this manifest,except as noted in Ilem 19. <br /> Data <br /> 1 T Printed/Typed Name .. Signature -' Month- Day 'r Year. <br /> F-1402002 1�►BELMASf'FR®f800}821-51308 www.labelmaster.can aairneaoagrcraeoruen 'Rev.3195 <br /> "Mr.iwr[n w�rx . <br />