Laserfiche WebLink
NO ►ZARDOUS WASTE MAN <br /> Please print or type {Form designed for use on elite(12 pitch)lypevmter)- 7T�7 <br /> Mani est <br /> Page.1 <br /> NON-HAZARDOUS •Generator s us EPA ID Na Document No <br /> WASTE MANIFEST_ . C ' g ' - <br /> � . <br /> -3.Generators Nemo and Mailing Address-- - - <br /> �fj,-d:4 Ysarn. -Xr u <br /> rLtati -W7a'merco-,--CA,,:. ` -" - <br /> f 4.GeneFatar'sPhone( 32 ' -215� 37,�� ' <br /> um " R State Transportees 1P <br /> 5.Transporter 1 Company Name - •6 US EPA ID N _ <br /> it -1, enc. CAT, T) .�' Transporter 1 Phoria <br /> �.�L1S.6PA ig tjumbef - - 4:, C.-State TransportePalD. <br /> 7:Transporter 2 Company Name <br /> D:Transporter 2 Phone - <br /> 9.Designated Facility Name and Site Address '-US EPA ID Ndmbair r f - *;' -E State Faotlity's ID.r - <br /> . ,-, <br /> ulE f. �silVZ* ORiIiWXI <br /> Streit F FacifitysPhone <br /> A_�3`i ;a CA. 3 7 a CAL, T)0 ?�� 5�� 32 32"5.3-5 3 '1 <br /> 12.'.-,Containers 13. ' 14. <br /> 11.WASTE DESCRIPTION t, '.Total . Unit <br /> F No. Typo Quantity : WL/Vol. <br /> ±i.,1 hF"�Y3i'f.�cll�l�.7:i�3 L. �Y 711- LI YIP <br /> Cw b. <br /> E <br /> A :. <br /> :.O. <br /> R d. <br /> L: <br /> - <br /> Q G.Additional Descriptions fw Materials Listed Above H Handling Codes for Wastes Listed Abova.. <br /> �'- <br /> 3. 70fll13zar i i3 tr tar . <br /> Special Handling instructions and Additional Information '- ?lt o st atk oil Facii- it y - <br /> a; <br /> _ <br /> - 9 Piccolx <br /> Z . I.OV}7S �'x GL' : * cocoa, <br /> Z -Q - <br /> �` <br /> is of this'stii rrient are and accurately'described and AWAKMAWMAWMAVMMAWAVA <br /> FAW <br /> are In all respects.-.-- <br /> Ti -, _ y <br /> t the coriten <br /> -erti ,t a P ., <br /> -'•18.GENERATOR'S CERFICATION:]'hereby c fy h fully <br /> in'properconditiori-for transporl..The inater3als de5eribed on this manifest are not subject to-foderal hazardous waste'regulattons: <br /> :Date'` <br /> Pdnte ed Nana._. 5i9t t nth Day Year <br /> I)afe/ <br /> terlals•'.' <br /> f, <br /> Transporter.l.,Acknowletlgement of Receipt of Ma ,_t <br /> R <br /> Pri ped Name �r Srgnatu Month"': Day Year <br /> :. <br /> Transporter 2 Acknowledgement of Receipt of Materials :.; <br /> Date. <br /> R d Name Signature' Month''„.Day Yaar <br /> Printed/T <br /> •. T <br /> >_ <br /> E <br /> R <br /> tp,Discrepanay.Ind�cationSpace - _ <br /> r F RECEIVED FSB 0 70 <br /> h A F. <br /> -�I 20.`Facllity,Owner or Operator Certlficatiori of receipt of the waste materialsJ. <br /> covered by chis manifest except as notedrn item 19 -_ <br /> E <br /> .Pnnted(Typed Name Signature Month Da) Yaar i <br /> I Y <br /> b_ f t4C2002 �Re(800}6214808 1 t".a4efmastercom a vHBlrEaoFiaFCvCCEDP�{ER rrx.rrenn,x :Rev 3I&5 . ; <br />