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NON-HAZARDOUS 1• Generator's US EPA Ip Na. Manifolf'; 2. Page 1 : <br /> WASTE MANIFEST °p of 1 <br /> 3. Ganarotars Noma and Moiling Addrass CI'.l'k .'h �:.j;�;i ii`.it F' �Ft; r101 stili lei.Tlr <br /> 411 a i1r a '?'ti%+� c^G'� jT?T, i•;tYk7 <br /> d. Generator's Phone <br /> S. Transportor 1 Comeony Nome !. US EPA 0 Numboi <br /> nrr <br /> 7. Transportor 2 Company Nome E, US EPA ID Number <br /> IP. <br /> I <br /> 9: Detionotaci Facility Norno and Site Address 10, US EPA ID Nvmbor' ! A. Tronipamer's Phone <br /> S. Transporter's Phone <br /> w 7;7 >C "` f"►� :tli_l:l,il': P ; C. Focliiiy's Phone <br /> 1890) 649--3471 } <br /> 11. Wasia Shipping Noma and Cowlption sl 12. Cvntolnors I9. 1�. <br /> iatssl I ilnr! <br /> l No. I Yypt Quantity Wt/Vot <br /> it <br /> T <br /> E <br /> E <br /> I <br /> A <br /> D. Additional Dosir,.pl o s lar Maleriofs ll:fuci Abavo IL t E. Hon669 Codas for Wostas.Med Above <br /> 'II A. ^;0r, Cfitfir`�:'.T}`��'?;�) r�.i'Li•' Ii'(.^^r'�(?};sir:�;�:i ��. i <br /> ,'V 'T ICiN,r, 111r,"INTr,.,,y <br /> 13, Spoaol Hondlinq Instructions and Addirionei!nformotion li <br /> wr., <br /> S.XA, fit.Vj CA 95207 <br /> `4�3L T{� 11? i!F }4i"r T'.t r��►,r�'{ i U <br /> 18.GENERATOR'S CERTIFICATION; 3 cerrlfy t>so malorich dnwrr6ed obo,a �n the monifost aro not wbiocr'ro lcdordl ro10a6onr toe roportiaq proacr d4poiat o1 Horortiow Wain. <br /> Primod/.Typed darn* I Sipnafurn ` „f .. Monett Day y4ar <br /> T 17,Transportor I ACltrowlcdaamvnt o! Recaiot of Motoricls L I 1 <br /> AMnlad/Typed Nam* 5ignotvre f i Monih Day Year <br /> " <br /> 0 18.7ronsp4rtor 2 A<knowlcdQu�nant of Ruccipt of Motoriols 1� I{ <br /> TPrinted/Typed Noma 4 5ignotvre ' 'lr4ansh Doy yavr <br /> 19.Discrepancy Indicoiian Spore <br /> A <br /> C j <br /> L24.Facility Owmor or Cporotor:Cartifliclion of receipt of wasia moterrols covared by Chit monifast except os;iotod in Ilam 19. <br /> Y — <br /> r6Vpd/Ty c Noma Jay Ynor <br /> eZ• _ <br />