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- . r A of=�tsn�-it ##3757 <br /> N&TAZARDOUS WASTE MAN1V,.-T.: . . /715,1-3 5 !:M .a.m <br /> Piease print or type (Form designed for use on eVite(12 pitch)typewriter) - - - - - <br /> _ Manifest 2,Page 1. _ <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Document No. �- <br /> WASTE MANIFEST co X32 �3. `25i jet � <br /> 3.Generator's Name and Mailing Address c. <br /> - +.3 if i�3 4-aatara 5ratcar:3 -- At�:tz: ?a: <br /> 233 3�aiii"a Strvat, Canaerc , Ca. 333!3 <br /> • <br /> 4.Generator's Phone( 323) 254—jll <br /> 5.Transporter i Company Name 6. US EPA M Number A.State Transporter's 0 <br /> 9—J <br /> .oat Trans, Lie. CAS .333 112 3)'7 B.Transporter I Phone <br /> 7.Transporter 2 Company Name - B. _ US EPA ID Number C:Sta1e Transporters ID - -D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA SD Number E-Slate Facility's 10 <br /> Iainaly-Ea Y ir a-,aaaatal <br /> 13 7 � T':. �r xitar:�... tr'3°? F.Facility s Phone 7 1L'i r,. �" 3� <br /> Ch. 92335 CAL •333 233 J33 <br /> . 12. Containers 13. - 14 <br /> 11.WASTE DESCRIPTION - Total Unit <br /> No. Type Quantity WIPOL <br /> a. <br /> r.-DO-13 LIQUIT, <br /> G b. <br /> E <br /> E <br /> A <br /> 0 d. <br /> W R <br /> N _M', H.HandVing_Codes for Wastes Listed Above - <br /> Q G.Additional Descriptions for Mgferials Listed Above <br /> - <br /> Q 15.Special dandling Instructions and Additional fnforma6on ' J . site:tib: 7� FRE J� Fac-.L�1�y <br /> % i 1983 Piccali ':fid. <br /> Z ,LOVES GO IME3 .Stac.`::taa," C_1. <br /> Z : <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of.this shipment are fully and accurately described and are in all respecEs <br /> in proper condition for transport.The materials described on this manliest are not subject to federal hazardous waste regulations. <br /> Date <br /> MO Da <br /> Printedfryped Name Sign wre x B <br /> Dale <br /> TR 17.Transporter 1 Acknowledgement of Receipt ofJMateriils <br /> A P" yped �Name Signai M n Day .Year <br /> S = - ` <br /> P <br /> pale <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name 'Signature Month Day Year <br /> T <br /> E <br /> R <br /> 19,Discrepancy Indication Space <br /> F <br /> A <br /> I i 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. - - - <br /> Date <br /> T Prinled(Typed Name V- Signature Month Day "Year <br /> - • Rev.3195 - <br /> F-1402002 L.ABELAASM0(8W)621-WB www.Iabelmaster.00m._ PRWE pNRECYCLED PAPER rinx,rowlrx ,q,,.,�, <br />