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. . " T <br /> N AZARDOUS WASTE MAN <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) - <br /> NON-HAZARDOUS t.Generator's US EPA ID No. 'Manifest 2.Page 1 <br /> Document No. <br /> WASTE MANIFEST. CSD 982 .508 251 of <br /> 3.Generator's Name and Mailing Address <br /> 'Jnifie t 4est_ern �c�cers - Attn: Pad C�.ii1_lar. y <br /> 5200 S=aeila Street,' Co:jterce, CA. - 90040 <br /> 4.Generators Phone( 32.3 264-5200 <br /> 5.Transporter 1 Company Name - - 6. US EPA ID Number -O t7 A.State Transporter's ID <br /> L'I.C. - C1T 080 0Vita 12 S.Transparter 1 Pfione _a . <br /> 7.Transporter 2 Company Name - - 8. - - US EPA ID Number C.State Transporter's ID - <br /> D.Transporter 2 Phone <br /> 9.Designated facility Name and Site Address 10, US EPA 1D Number E.State Facility's ID <br /> Re:* ly Di.viromental <br /> 3200 . .Trbntera Seel. -F.Facility's Phone <br /> Nnallliem CA. 92306 CU 000 200 500 714-530-2307 <br /> 11.WASTE DESCRIPTION - - - 12. Containers 13- - = 14. <br /> Total Unit <br /> Na. Type Quantity Wt(Vot. <br /> a• <br /> ;T)Ii ),ZVMJS LIVIDS <br /> G b. <br /> N <br /> R a <br /> A <br /> W R d. I <br /> I N <br /> QG.Additional Descriptions for Materials Listed Abode .H..Handling Codes for Wastes Listed Above , <br /> N a.) nen--�iazar.3o3s water. <br /> o �It3FTLE #04--Tom'-a1-099' <br /> Q15.Special Handling Instructions and Additional Information Jdb- Site:- Sto&t on Facility <br /> _ <br /> 1,990 ?iccoli R.I.'. <br /> Z <br /> mo 1, .& Gx .Stoc'cori, Cx. 95215 <br /> 0 <br /> z9a9_8f39-56Q7 <br /> iWAWA r MAW AF-A <br /> .: <br /> ' 16.GENERATOR'S CERTIFiCATIQN:I hereby certify that the contents of this shipment are fully and accurately described and are ln.alt respects <br /> in proper condition for transport.The matemes described on this manifest are not subject to federal hazardous waste regulations-, <br /> -.Date <br /> Printedi yped i Nam Signal u c Month� Day Year V7 <br /> 71 <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials ' Date <br /> A Print yp d Name L'% Z Signet a ,'f Month Day Year <br /> S <br /> u'EJ� z z7 b I <br /> P <br /> i p 18.Transporter 2 Acknowledgement of Receipt of Materials - - Date <br /> f T PrintedlTyped Name Signature Month Day Year' <br /> i E <br /> R <br /> 19.Discrepancy Indication Space - <br /> .. - <br /> C <br /> 20.Facility Owner or Operator;Certification of receipt of themaste materials covered by this manifest,except as noted in item 19: <br /> Date <br /> T "Printed/typed Name Signature Month Day : Year <br /> F-1402002 LABEIMI►57E1t®(800)6215808 www-Iabalmaster.com �PRINTED ONRECYC=PAPER Rev.3195 <br /> ILSINC.SnVPFAN INN ClH rYY <br />