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N�AZARDOUS WASTE MANN <br /> _ �-, <br /> Please print or type (Form designed for use on eine(12 pitch)typewriter). <br /> Manifest 2.Page 1 _ <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Document No, <br /> 0, <br /> WASTE MANIFEST CAO 932 503 251 <br /> 3.Generator's Name and Mailing Address ' <br /> jaifierl .4estarn Grocers - Atta: .t?at ;ailler, ety _ <br /> 520! Sheila Street, Cazfterce, C4. 90040 <br /> 4.Generator's Phone( 323 764-520x} <br /> 6.- US EPA ID Number A.State Transporters ID <br /> 5.Transporter 1 Company Name <br /> )i3z la �r3 3, Inc. CAr '08:3 012 31�t� B.Tmnspo to I Phone TiS89-5 <br /> 7.Transporter 2 Company Name B. USE ID Number C.State Transporters 11) <br /> 'D.Transporter 2 Phone <br /> 9.Designated Facility Namepci Site Address - 10. US EPA ID Number E.State Facility's ID <br /> eaed y` Eaviro-iraeTstal <br /> 3200 S. Froatera Street F..Facility's Phone <br /> Ana'aeir°r, CA, 9250 C.1I 3E10 2t30� 5130 714-530-2307 <br /> 12. Containers 13. Unit <br /> 11.WASTE DESCRIPTION - - _ - Total Unit <br /> No. Type Ouantity Wt.Nc1. <br /> a. <br /> _ ST(7\; -�]`� ITRIS1i .( �i T{4 rT`7;"�Cj 1 <br /> .I . 71 <br /> ._.�rk,l� it�iZAR V,� WAS1.J LA UID - <br /> G b <br /> N <br /> R <br /> ' I <br /> • d• - - <br /> W <br /> a :G.Additional Descriptions for Materials Listed Above ` H.Handling Codes for Wastes Listed Above <br /> N 3.) aon��iazariou� teeter <br /> 1 <br /> r Q PROFILE #04-TTT--;11-069 <br /> a 15.Spe{ial Handling Instructions and Additional InformationJob, Site: S/t�[ocktoa 'Facility <br /> 1990 Pic6oli Rd. <br /> Z GLOVES & GOGGLES Stocktoa, GA. 9521.5 <br /> Z F.n 4909-339-5607 <br /> i <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 regulations, <br /> Date. <br /> Printedrr ed Name S�gO fg U�y ` , Month Day Ye <br /> i AJ <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials - q - .�" Date <br /> A <br /> i� N Pnnte�e Fm Sign r Month Day Year <br /> P 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> O ge <br /> TPrintodrTyped Name Signature Month Day Year <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 /> L Date <br /> Y Printedrryped Name Signature Month Day Year <br /> Y <br /> i <br />�, F-14012002. LAuLAASTER*(800)821-5808 www.wmjmaste,,c*m �PpirrrEO FICCvaFOPMERev.3195 ' <br />