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4 it� <br /> N01.-HAZARDOUS WASTE MANS► _ST <br /> Please pnAt or type (Form designed for use on aide(12 pitch)typewriter) <br /> x� NON-HAZARDOUS 1 Generators US EPA ID No Manifest 2 Paga 1 <br /> Document No 1 9 7 1' WASTE MANIFEST <br /> �i 3 Generator's Name and Mailing Address <br /> U.S. Gas, cla GaUfornia Geophysical Group <br /> 1 P.O. BOR 518341 <br /> ` ogtop{tone CA 95357 <br /> 4eneradf�tor's ( Attn. Carolyn Cuss <br /> en <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A State Transporters ID <br /> z General Environmental M t Inc. <br /> r3f11 GAD 9 8 3 6 4 9 6 B D E3 Transporter 1 Phone 800-326-1011 <br /> 7 Tran <br /> sporter 2 Company Name 6 US EPA!D Number C State Transporters ID <br /> D Transporter 2 Phone <br /> 1 9 Designated Facility flame and Site Address 10 US EPA ID Number E State Facitdy s IU <br /> GEM Rancho Cordova, LLC <br /> 1185S White Rock Road F Facility aPhone <br /> Rancho Cordova, CPQ 95742 1 C A D 9 8 0 8 8 4 18 3 916 351 0980 <br />' 11 WASTE DESCRIPTION 12 Containers 13 14 <br /> i Total Unit <br /> No Type Quantity Wt Noll <br /> a <br />' Ron haxardoua solid (toil Cuttings) 007 <br /> � D M P <br /> G b <br /> E .^ <br /> Y ` 9 <br /> r Y L'v 1+JrG.es.a �.erjgV f"J r ,e„ •K'c <br /> T Gv <br /> ') )'4�. i 9� <br /> O <br /> R <br /> W <br /> F <br /> I <br /> G Addrtional Descriptions for Matenals Listed Above H Handling Codes for Wastes Listed Above <br /> ilk}R8503 Soil CilttiJ1g8 <br /> a w� � <br /> 1 N 15 Special Handling Instructions and Additional Information <br /> Emergency Phone: (800) 326-1011 (far GEM) , Container Size 11a) 55gal <br /> Z� <br /> O �w Sita Address: 749 East Charter Way, Stockton, CA 95206 <br /> 1Ja <br /> 16 GENERATORS CERTIFICATION I=1-.d". <br /> ereby certify that the contents of this shipment are fully and accurately described and are in all respects` <br /> in proper oondrtion lot transport The materials described on this manifest are not subject to federal hazardous waste regulations <br /> Date <br /> I <br /> a3liirrs •G RS Srgn re �d� u' S. A 4 Mortfh Day Year <br /> TR 17 Transporter 1 Acknowledgement of Receipt of Materials Date <br /> I IN P-rype-d Nam Sign re Month I <br /> /Day Year <br /> , i <br /> P . y <br /> R 8 Transporter 2 Acknowledgement at Receipt of Materials <br /> Date„ <br /> T PnntedrTyped Name Signature Montt? Day ,Year <br /> E <br /> R <br /> F 19 Discrepancy Indication Space <br /> ` & C <br /> 1 20 Facility Owner or Operator Certification of receipt of the waste malenals covered by this manifest except as noted in item 19 <br /> L <br /> Date <br /> T P Yped Name Signature Month Day Year <br /> C2002 LA1S�,�!\STFAC <800)6215608 vwwlabelmastercoin 0 <br />