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AL fA ENVIRONMENTAL SERVICES, INC. <br /> §3�1 Da/vis St. p -- ------ �[ <br /> V�eiv t ,' A �d687 <br /> (NO)784-12768 <br /> f�d 1 i <br /> 'leeaa print or( a' 3 r.t, �t ( { <br /> rarfn daa ned�u -bn flits 1 11 RUN= <br /> - <br /> 1 Generator's US EPA ID No Manifest 2 Page 1 - I <br /> NON-HAZARDOUS _ h�PL� �-tr Document No of61 <br /> WASTE MANIFEST _T <br /> Generator s Nome and Mailing Addrejs <br /> i <br /> 4 Grnr.roior s Phone( l <br /> ii <br /> i 5 Transporter 1 Company Name 6 SEP ID Number <br /> � <br /> 7 Transp,rter 2 Company Nome 8 US EPA ID Number <br /> i _ {E <br /> I — -- € <br /> I 9 Designated Facility Name and Site Address 10 U5 EPA ID Number A Transporters Phone i <br /> s 4.- <br /> tr7-�lam. B Transporter's Phone <br /> PI-D P' C Facility IsP e <br /> -7 t>'I 94 0 = <br /> 12 Containers <br /> 13 I <br /> 1 1 Wosle Shipplrsg Mame and Description <br /> Total Unit I <br /> { No T pe Clucintit Wt/Vol <br /> I <br /> b <br /> WEIGHMASTER CERTIFICATE <br /> IS TO CER I IFY Ilial the following described carrtrrtod y was weigtsed measured,or counted by e we+ghmasler whose signature ie on this cartiicale wfia s a recognized aulhonty of eccutaCy as prescnbed by <br /> ,cr 7(corlrtn iscing with Section 12706)of Drvssion 5 of Ilia Ca4fornia Busnesa and Protesttons Code adknlnslered by the Dwisnn of Wasurernam Standards of the Caldomis Department of Food and Agriculture <br /> 1 <br /> T T(_KL I NO. 7613 11 <br /> t t t irh I ! �I�^ItaTtL [ Cr. �DC -1E DE-L 14 199.:, 15.r�1C, :.3`� <br /> . S11 Ic I' ri t i4i' kd. t'aC:ckvIe. L t.S31i m U d 1t 'i1 . .- 'ataiL <br /> , I , tltlil <br /> ' <br /> [ cot al CI-tar gyp . <br /> rlL -I ender ed <br /> 1 r 1 <br /> 1` <br /> 7') ll,'Wl i k` t 131 1 I l L I bs. <br /> 1 � i'•+ti'f l!t IJ� ' '.� I l t,b. it ti Illi' �f��LL <br /> f D itVcHS§IdNITURE DEPUTY WEIGHIVIASTER <br /> I GENERATOR S CERTIFICATION I c,,t,fy the rrsoieriah described o6o�e on inn marnlco are noE svblec to federal -gv lions for po nq proper is owl of Hoxoldo�s Wusta .�( �I <br /> Mon,h D. Y,..�r � <br /> F'n1 is,c4/T}pert Na S13nalur , <br /> a_ FALc7 c LC- .�� ��— t <br /> T 1/ 11 n bportt.r I Acknowledgement of Ruceipt of Materials <br /> Trg, <br /> p Printd/T ed N m� r~atur / � �y +J>4 <br /> p18 TrunsForter 2 Acknowledgement of Receipt of Materials <br /> Fl --- —_ - <br /> T Printtd/Typed Name Signature Month [lay Y�nr <br /> E <br /> R ' <br /> 19 Unsrr,panty Indication Space 1 <br /> I <br /> I <br /> r F l <br /> 20 Fac ilii/Owflcr or Operator Certification of rece'pt of waste materials cover4b,,n,,, ,nT,,,iexcept as noted 1n Item 19 <br /> T _ _ J/ <br /> �Z&Y <br /> i i1r1 fT ped Nom — mm <br /> /�7__ <br /> $lMonrRY <br /> I ! <br /> § <br /> Be%1 11 V) TRANSPORTER #1 <br /> l <br />