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ALTA MVIROWENTAL SERVICES.M <br /> -ire--_- es•—-T ---- --- -, --� —- ——--- -$31 1)8Y{S SL — - ---- - - - w-- - -- -w-- -- -- r= <br /> �'" #' i• y�F"�#`� 1 d ' Vamvige.CA 956B7 j y <br /> sap►,mor`�yp�a7� � 3� ��` (800)794-27$$ <br /> tri'daat9ned 1 tits oh sl y�` � `t r <br /> w� NON-HAZARDOUS 1 Gfn a attor ss US EP D No Man+fest 2 Pogo 1 <br /> WASTE MANIFEST p p t- 1e- Document No of <br />'b 3 G+.r♦er pr s ai a and n Address f <br /> t� I �' �' r�.r,�t•�—" 1 649 E Charinel l St <br /> GO, 551 13 , t>.ak-t0rI , (.a 95205 Stockton , Ca <br /> 4 Generator s Phone( 2 L) 9) 465-36509 <br /> 1 <br /> r - <br /> 5 l oonrier I C° Name 6 US EPA ID Number <br /> ater {" an rfi tic k -1rig A (408 ) 927-9321 <br /> r 7 Trorisporter 2 Company Name 8 US EPA ID Number <br /> 9e Ursignaled Facf rty Nome an to Address 10 US EPA ID Number A Transporters Phone <br /> t Cl I L o r,C] 'i i r n C <br /> B Transporter's Phone <br /> Ho", Rurid k A <br /> � �' ' !_ & C Fauh+�'s Phone( 707 ) 451-3275 <br /> 13 4 <br /> 11 Wosle Shipping Name and Description 12 Containers Total Unrt <br /> No Type Quante Wt Vol II <br /> ar. Itca7 Mr,dn11u It,+r:r rjcanhr�rl 1rTlnact Eo I - A(,( EPT _ 01 1 !j vd- _ 1 <br /> WEJGHMASTER CERTIFICATE <br /> IIS IS TO CER tIFY that the lollamV described cormrsly",,=measured•or counted b a weighmaster whose signature Is on this certificate who Is a rwogsired authority of accuracy as prescnbed by <br /> tapter 7(commenting onih Section 12700)of Dnn .5 of Ito Cusness and Proleasrons Code administered by the Dwisson of Wesumirrient Standards of the Catdorma Department 4A Food and Agriculture <br /> WI: : Ill i _ < r I • C I( 1(t-T NO. : 76694 <br /> I", 1 I e , , I u1,1+011 ' Cu. DO I L. UL C. 1, 1993 6 z,,:.=LI <br /> 13:: 1 ',r t, i '4L ( H.01' Rd t/,ir_AvI f 1 f'y l_,,. C ctlllfr+c,tJJl y :(. -'}la1L <br /> tai l fill Itl , t i '1 l fLlalil <br /> f i i l <br /> it hit k 1101,1C I;C Fri <br /> I R1 t l l utal Charge : <br /> lendered : V1 <br /> vril ')Ii + I I y r { i5l lrliret/Ilh C(1c.InCgE $0. Vito <br /> LAI I I I I f l tY } <br /> 7 i <br /> L. a /!}Irl (I i} (tl ri tt+ I ,tlrt k r�S <br /> ) f/!/ _,1141'1 I IIIII <br /> / ,tif_4eLt - Ili I tit I z t )r., ,idIUY I1HLL s <br /> rs ' , <br /> CIA G G",,ra DEPUTY WEIGHMASTER <br /> + <br /> lb GENERATOR S CERTIFICATION I cendy the motenats described above on this manefesi ore not subigg to federWregulat+ons lot reporting proper disposal of Hazardous Waste <br /> PnntLd/Typed Name Signature r J C—) Month Day Year <br /> V , , I re_r M I d I a1 1 g <br /> T 17_Trunsporter 1 Acknowledgement of Receipt of Materials <br /> H ,I <br /> "S Pr+ d/Typ N rSrgnatu J'�y'� <br /> rim {E [✓/`_tG. � , `D`1 <br /> P ---- �a <br /> O 18 Trunsporter 2 Acknowledgement of Receipt of Materials � t <br /> R <br /> T Printed/Typed Name Signature Momh Day -Year l <br /> R E <br /> i 19 Discrepancy Indication Space <br /> F <br /> A <br /> 20 Fuahty Owner or Operator Certification of receipt of waste materials covered by 1 is manifest except as noted in Item 19 <br /> T _ <br /> Print Typed Na e n Signal Mon o <br /> t t �Ea a TRANSPORTER #1 <br />