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02/07/2006 17: 18 9256340' DILLARD TRUCKIF PAGE 04/29 <br /> NO"I' "'AZl`•,R�"".'01 : 'ASTE MANIFEST <br /> Please pont or type (Form destpned for Lite an elite(12 ditch) _110r) <br /> NON-HAZARDOUS 1.Generarort US EPA 10 No. MAnil—t 2.Page 1 <br /> WASTE MANIFESTDocum9nl Na. <br /> 1... ';0..6 or. 1 <br /> 3.Generators NameandMailing Atltlrr•'tt- -MOT <br /> �.,CO T,4i"RODUC O,- XPTPCc <br /> .fY�W ro�$#5.- :_ ..... ..�.. .. .. :r,iV!�11 R/aLr.pVfrA47"1�w..._ ,. .:rr .. •:d+.. <br /> 8100 H. HJtMMMY .49 Rss MARGAUXTA CAL.- 512688, <br /> IiS 'tO1R, G1►. . _ AST�s. ,H CI�RIB�I : <br /> 360 ,0205 <br /> 4.Genermofa Pnona(. <br /> .-..t 5.Tmnspartqr t Company Name 8. Uo EPA 10 Number A.state Transporters ID <br /> Dili-ARM 1L s Tj LCA D 9 B 2 5 2-3 4. 3 4 B.Transporter 1 Phone (925.1-634-6" <br /> 7,Transporter 2 Company Noma S. U9 EPA 10 Number C.Stato Transpodor't ID <br /> _ D.Transporter 2 Phone <br /> H.Desiiggna�ted�Fe�cihity N-,mr�n and Sian A_ddM53r.T7 7 10, US EPA ID Numher F.State Facillry'.?10 <br /> 9999 900TK AVBTIN ROAD <br /> .,..aMIi'iCl4, C&._9S32&,. <br /> F.FaF111ty's Phone <br /> C, A L 0 0 0 1 9 O 0. 8 0. 204 982-4298 <br /> t1.WA87E DESOMPTICN 12. Contalnort 13, 1d. <br /> -rolumi <br /> No. Typo ouentity 1^yt,Nal, <br /> a. HiLE l WOUIL 40M r -4Pf= <br /> 00. . . D..._ ... .. _. <br /> G a. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> O — -- — <br /> R d. <br /> F-� <br /> _0 <br /> 6,Additional Descoptlont for Mmenals Listed Above H.Handling Codes tar Wastes Luted Above <br /> i <br /> 11L. <br /> 110. 1�� 1 :� ?11QF <br /> lid. <br /> Z ,` <br /> IS.Special Handling Inetructiont and Addittanal Inlonnation <br /> _ EM&raencV Contatet(S251634-6830 p.tr.LARD <br /> doe• fA -1-3xg••. <br /> O <br /> Ile.GENERATOR'S CERTIFICATION:I P+orahyy ceNly that fhe contents ai rh{a shipment are(uNY ane eccuralery tleecrinmd end aro in all rntpa= <br /> In pmoer condltlDn for transport.Tho matorlAls ddtcribed on Chia mArgt;t ars riot euWect to federal hezerooue woaf-t mgulation <br /> Date <br /> Printed Typod Name naturo <br /> MwrNr Oay Year <br /> R17.Trprtsporn3r 1 Acknowtadgament of R9celot at Materlale Date <br /> N iuro Month Day year <br /> PrintedrTyped Name Slgna <br /> S <br /> P <br /> C) 18.Transporter 2 Acknowledgement of Receipt of Matorlals OatB <br /> R <br /> T PrintadrrypedName Slpnature Mwrh Day Year <br /> E <br /> R <br /> F 19.Dlsompancy Indlcatlan Space <br /> A <br /> C <br /> 1 20.Kacllity Owner or operator,Confliotdgn of rndntpt Of the waste MAID Ale COvared by"a mentfest,except as noted i 1 item 19. <br /> L <br /> Date <br /> 'T' PrtrrtadrTypad Nana Signature MorrrN Day Year <br /> Y , <br /> CF1a 9Rpa2 LAMELASTIR® (300)421-53De www.tabNmmr.r.cern <br />