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I <br /> - . AZARDOUS WASTE MWAST <br /> >. O <br /> N <br /> Please print or type (Fo m designed for use on el's{e(12 pitch)typewriter) Manifest 2-Page 1 <br /> NON-HAZARDOUS 1.Generator s US EPA ID No. Documenl Ne. j1 of t <br /> WASTE MANIFEST `� '� X12 � � <br /> 3.Generators Name and Mailing Address , <br /> '3;�i.�iv ` ;_ trla ``';rcar.3 — ��t3: z'3 ,riil�f�r:a°3C <br /> _tr-W w 5 'aarc.a, ^: . 41 <br /> ` <br /> 4.Generator's;Phone( 32'1 2i4-32100 <br /> 5.Transporter 1 Company Name 6. US EPA ID Numbe(y �S � A.State Transporters ID <br /> "Tnia-3, lac. �Y311) ' :! 3V R H.Transporter 1 Phone <br /> 1,121 Aat <br /> g, US EPA ID Number - C.State Transporters 1D <br /> 7.Transporter 2 Company Name <br /> D.Transporter 2 Phone <br /> 1p• US EPA ID Number E.State Facility's ID <br /> 9.Designated Facility Name and Site Address - - <br /> 1ait31,1 E_rr1.r a5><a-3at:1, <br /> ,320f 8. Fr 7"Li.ar:� L1" � F.Facilty's Phans <br /> >~• ;7 -}J YT7�,+-a 3') •2311 <br /> Aaa"Ieta' CA. 14 <br /> 12. Containers Total Unii <br /> 11.WASTE DESCRIPTION Quantity Wt.Nol. <br /> No- Type <br /> a. <br /> b. <br /> T { <br /> O I <br /> ll,f R d � <br /> N _ - ;Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions Tor Materials Listed Above <br /> N.. 3:) X3;3;1—i]i.LU3 '',t3CVX :. <br /> cc <br /> N <br /> .15.Special Handling instructions and Additional information J 1 a.•Si°:.:.: )�';aC. �.'1 �`;3Ctlitfi <br /> Q <br /> 11)9'.) ?kcal <br /> 115215._ 1 <br /> Z - <br /> 16.GEN£RATOA'5 CERTIFICATION:I hereby certify that the contents of this SNpment are fully and accurately described and are in all respects - <br /> in proper conditon for transport.The materials described-on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> r r Month Day Year <br /> Signature. j r <br /> Printe yPed Name., � �^iy. <br /> ) <br /> � �, Date <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials - ' <br /> R Signature Month Day Year <br /> A Pn�ypad Name <br /> NZJ r77 <br /> P Date <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials - <br /> O <br /> RPrintecirryped Name Signature Month Day Yea, <br /> T <br /> R <br /> 19.Discrepancy Indication Space - - <br /> F <br /> A <br /> 28.Facility Owner or Operator,Certification of receipt o1 the waste materials covered by this manifest,except asdoted in item 19. <br /> Date <br /> L <br /> T Printed/Typed Name Signature Month Day Year <br />` <br /> Rey,3x95 <br /> F-i4©2002 L ABELM/tiSTFA®f80f))621 5808 www.labelmasiar.com Pr11tIFEo ON RECYCLED PAPER <br />