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Nor,-IRAZARDOUS WASTE MAN .',-4 <br /> Please print or type (Form designed For use on elite(12 pitch)typewriter) <br /> Manifest 2,Page 1 <br /> NON-HAZARDOUS 1•Generator s US EPA 1D No. Document No. <br /> WASTE MANIFEST of <br /> 3.Generators Name and Maifing Address ' <br /> J�lif.lei .�est'�rax r3r�c rs - Atta: ?at ai:ll-ermety <br /> 5200 Saeila 5tra2t, ^l»:aare�, ^1. 9t7 � <br /> 4.Generators Phone( 313 264-5200 <br /> 5.Transporter 1 Company Name 5. US EPA 16 Number - A.State Transporters ID <br /> 3 .`�:it rx 3 13 I:1C C. <br /> CIT t 0 1 0 H.Transporter 1 Phone 909' 39-5 50 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporters tD ' <br /> D,Transporter 2 Phone - - <br /> 9.Designated Facility Name and Site Address. 10. US EPA ID,Number E.State Facility's D <br /> : n�3y F.ivir'aamaita'1 <br /> ��a E. FTJt�r3 Strut - F.FacititysPhone <br /> �}2�3 35 CyL 01,T) 2>J 51-10 .. 714--530-2307 <br /> 12. Containers 13. 14. <br /> 11.WASTE DESCRIPTION.. <br /> Total Unit ' <br /> Na. Type Quantity Wt.Nol. <br /> a. <br /> q01-'L-kZXZBOJS 'JX,3TF. LI' 1IDS , <br /> G b. - ... <br /> R C. <br /> i <br /> A <br /> R d. <br /> LU <br /> H <br /> a •G.Additional Descriptions for Materials Listed Above - H.Handling Codes for Wastes Listed Above ' <br /> a <br /> O PROFILE 104-: fr-'}1�059 <br /> D ' <br /> N 15.Special Handling Instructions and Additional Information - �'�� �:, ,?� :?1 Facility <br /> ' <br /> a _ <br /> 19')0 ?icrnli 1:1. <br /> E r�,� ^n 3toc� tat, . CA, 95.215 <br /> Z. '3LilY�,S $c. +.7iJ�3JL�J <br /> O <br /> .z Rip 9-3,39-56107 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that tate 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 regulations. <br /> Data <br /> f Printedrryped Name "Si nature Month Day Year <br /> )60,4/r- <br /> i l <br /> T 17,Transporter 1 Acknowledgement of Receipt of Materials -- <br /> Date <br /> l p Pnn ed Name Sign r f' Moth Day Year <br /> ve <br /> PO 18.Transporter 2 Acknowt dgement of Receipt of Materials - -Date <br /> Si Month <br /> T nature Day Year <br /> Printed/Typed Name g <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <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 /> Month <br /> TPrintedlTyped Name Signature Day_ Year ~' <br /> , <br /> II Y <br /> F-14 0 2002 UADELN1ASfER®(gpp)621-5808 www.labelmaster.comPAJkTW6 N RECYCLEb PAPER rn ,. Rev.3795 <br />