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ANIS <br /> .-t N.Oh-YAZARD.OUS WASTE M <br /> Please print ar type (Form designed for use.on elite(12 pdah)typewriter) - Manifest .2.Page t <br /> NON'HAZAR�OUS f Generators US EPA ID No Document No ',5 51 - <br /> of 1` <br /> WASTE MANIFEST--: <br /> c'AD- 32'.:59 y1 <br /> -3.Generator'sNameandMailirig•Address' - <br /> Clnified '�'estarn ui-ocer�i� At'tn. �at-Caillermety <br /> 52 J Sheila` Street, Commerce, C.A. 9 C <br /> _ '4.Generator's Phone( '323 - 54 5200 - <br /> g US EPA ID Number A.State Transporter's ID <br /> S.Transporter 1'Company Name r: i <br /> kIaz at Traria Inc :.' <br /> --. CAT 011 00.212- 370 - B.Transporter 1 Phone 499-359-5 '�7 <br /> 7.Transporter 2 Company Name' : - 8. . -US EPA ID Number, - : C.State Transporter's ID - <br /> - D.Transporter 2 Phoria <br /> �9.Designated Facility-Name and Site Address 19. ..,US EPA IDNumber - - E.State Facility's ID- <br /> emed.y.' Environf�ent3} <br /> 32� F. Fr6ht@Ta.:St:reet F.Faci4itysPhene <br /> As7heiia CA. 92305 CAL: �J90 ?� S'}�3 323-25r3=575' <br /> . Containers <br /> 11'.WASTEDESCRiPTIOf l Taia1 Unit ' <br /> " No. Type- F Quantity " <br /> a <br /> idON—"L�ZARKU1S °�)ASTF'..LI` U'12S <br /> G b. <br /> LAM , d.- - - - - - - <br />` QQ G Additional Descriptions for Materials Listed Above H.Handling Codes for.Wastes Listed Above <br /> a.)..non Iiazar3�u� grater, <br /> D.. ��' OFILE '?4 '1T-�1=05 <br /> 15.Special HandlinglnsWctlonsandAddRionalinformation 3.Qb'.SitatACko>l FaC311ty <br /> _.. .199(}'Ficcolt�.' <br /> Z _GLOVE'S 1g SOGLFS Stockton, . CA. 95215 <br /> Z --5 <br /> AV iit& . <br /> t8.GENERATpR'S CERTIFfCATIQNi!hereby.certify ifia[,[he contents of this shipment ate fully and accurately described and'are in sit reaper Es <br /> in proper condifioh for trangport;The.matenais desor bed ori this manifest are not sub;ect to federal hazardous waste regulaSions:. <br /> Date` <br /> Prin ed Name Ss [" nth Day Year <br /> Z' . <br /> -T 17.Transporter 1 Acknowledgementof,Reoeipt,of Matenafs' ': Data <br /> A. P yP Name ' Signa Month - Day. Year. - <br /> N. 47- <br /> $ wl amens✓ <br /> t of Races tot Materials Daie <br /> . •-18.Transporter 2 ck edg P - __ <br /> T. PrintedlTyped Name Slgnawre r Month Day; Year. <br /> I E, <br /> R'. <br /> Discrepancy Intlicatlan Space <br /> :.. <br /> F RECEIVED <br /> _ <br /> CEIYEb Q 7. : <br /> I C <br /> I <br /> '20.-Facility Owner'or Operator,Certification of receipt of the waste materials co_vered by this manifest except as noted in item 19 <br /> LDat <br /> T PrintedlTyped.Name._ -Signature March Day: Year _ <br /> r <br /> .c,--,,F-1402002 - ® 621.6806 WWW.Iabelmaaler.001r1 �.VAItlfEb ON RECYCLED VAPER Ilieo wic <br /> ,:.,.:. _ <br /> L/ t'wi FA ._IB001 Y <br /> - .._..._...,M. .-.... ..,. `Rev 3195, <br />