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N&)"I"JZARDOUS WASTE MA _ <br /> :Ptease pdnt or type (Form designed for use on elite 02 pitch)typewriter} Manifest2.page 1 <br /> NON-HAZARDOUS 1.Generator's US EPA 1D No. Document <br /> of <br /> Document No. <br /> ' WASTE MANIFEST CAn' 432 5,"YS 251 <br /> 3.Generator's Name and Mailing Address <br /> nifie'1 astar.z Grucwrs - 8ttn: Pat Guillenuaty <br /> 52109 Szwila Str'eat, Co mairce, CC, _91940 <br /> 4.Generators Phone( 32�3 264-5200 _ <br /> S.Transporter 1 Company Name 6. US-EPA ID Number A:State Transperte•s @ <br /> Jaz, `13t Tra3,. Itzc. CAT fl3'l J12' 8(30 B.Transporter,PhSne '�09-389-56J7 <br /> 7.Transporter 2 Company Name - -8. US EPA ID Number - G.State Transporters ID <br /> D.Transporter 2 Phone <br /> 9,Designated Facility Name and Site Address - 10., US EPA I❑Number E.State Facility's ID <br /> Remaly Eavirvuwieata1 <br /> 320? E. -kroatrra atre�at F.FacititysPhone <br /> CA. 92306 CLX 00.210 714-630--2307 ; <br /> 12. Containers -.33. - 14. ' <br /> f11.WASTE DESCRIPTION - - Total Unit <br /> No, <br /> Type Quantity .. Wt.Noi:, <br /> a � <br /> J0-4_$..1A?A,.WJ3 'IASTE.Ll,'.)-JIOS <br /> rE b. r+1006 <br /> N <br /> E. <br /> R-A. O <br /> T <br /> W a. : <br /> QH.Handling Codes for Wasteslisted Abbve- <br /> G.Additional Descripuons'for Materials Listed Above <br /> hoin�qaxar-.buL3 -water <br /> Q :. -10EILE #04.-MT-01l 069 <br /> Q15,Special Handling Instructions and Additional Information Job Site: Stockton. Facility <br /> Z CLOVES & GOGGLES Stxtctotl, CA. 95215 <br /> t Zir <br /> 9 <br /> k <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects ' <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regutations. . <br /> Date <br /> i <br /> PrintedlT ed NamaSignature Month DyJYear <br /> e� .3 <br /> T 17,Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A PrintgdrTyped Name Signa <br /> (ur Month-' Day Year <br /> p18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> 7 <br /> Morrfh Day Year <br /> Printecirryped Name Signature <br /> E <br /> I R <br /> ' 19.Discrepancy Indication Space - <br /> I A , _ I <br /> C <br /> 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 /> i -_ <br /> r T PrintedlTyped Name Signature' .• - Month Day .Year <br /> Y - _ <br /> 1 <br /> F-1402002' <br /> -1402002' i..ABEf..k* TU®(804)6215808 www.labelmaster.eortt PRINTED Oh REcvMo PAPER Rev.3196 <br />. USING SOYBEAN INK I e�JJ C[lv rpr(r . <br />