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02/07/2006 17: 18 925634OR74 DILLARD TRUCKING' PAGE 08/29 <br /> NON-HAZARnoos WASTE F IANIFEST <br /> Pieaxo not-Npn (Form deelgned for Use on elite(12 pitch)typewriter) <br /> rA <br /> HAZARDOUS 1.Oen US EPA ID No. ManHeat 2.Pago 1 <br /> TE MANIFEST OocUmRmNo. <br /> a 2 2 6..S.6,,. . 1.•1.?. 1.G, Of 1_ <br /> Nema and Mailing Address. mxm:,$p am-COAST <br /> PMUCTS r, LLC <br /> #595..: <br /> !9 HIGMay 99 RS, b TTL G 92689. <br /> hOng('t ,AT.x�:. +�i =a=1.i� <br /> A41970- 202 HYRF36010205 <br /> 5,rran5portar 1 Comasny Namn e. US 0PA ID Number A,State Transporters IDQXZ&AB&_zfiZLRozNzmyjw xycz, CA B- <br /> 9 0 2 5_2_14 3 1,B.Transporter 1 Phone 92� Sq�„gpa <br /> 3.Tran=oonnr 2 Company Name A. US EPA ID Numbrar C.State Transporters ID <br /> D.Trdnppartwr 2 PI <br /> De�Slanattm Facinty Name and Slid Addra, T7* tQ, US EPA ID N—b., E.Stator PRpl IP/v 10 <br /> +�/RMOD. IRC. FII&. 4 <br /> 9999 SOUTH ]►a9T.:tx Raw <br /> 1GliTRC�,....E11._9'5336 F.Feclllty3 Phone <br /> IC-A 0 0 0 1 9 0 0 8 0 209 992-4298 <br /> 11.WASTE DESCRIPTION 13 16 <br /> 12. renl9lnere <br /> Tow LIM <br /> Na. Type Quantity W1NC1. <br /> s. <br /> RON HAMMODS. 2013L, (pf:. 60877), <br /> IL 91 T <br /> va— 0 T y <br /> G b I <br /> N I <br /> E <br /> R �• <br /> A <br /> T <br /> O <br /> R a, <br /> Q � <br /> G.Addlflangl 0eecnptivne for Materials Listed Above N,Hendlinq Codes for Wastes Listed Abovo <br /> 11a. 6087 <br /> 11d. <br /> 15.Spn[AI Hnndlk,y Inatructbne and Atldtllonel InformsAon <br /> C rgeney COnta A023)-634-6850 DlLLARD <br /> O <br /> 18.aE roper C OR'S CERTIFICATION;I Hereby Certify that ttw canents d INS eMpment ere h,Fr and nc1urc t Fy aeeW Id and 318,11 all ree0eera <br /> In pro Def Condition for tri+naport.The rtlerer is descilbed on thls manifest sit net:ubjoct to fRdoml tRZardeue waste reptilations. <br /> Oats <br /> Printed/Typed Name `�� Sign re — Month Day Year <br /> U. 604= MR AvdO <br /> TT 17.Transeortef i AClrnowlndgamunt of RRCelpt of Maierlale Data, <br /> A Printeafryped Name nature <br /> N 9 Month Day Yoar <br /> .Qi <br /> P _ <br /> p 18.Traneponor2 Aaknowledpement of Recelpt of Materials <br /> E Printod7ypad Nwrur Slgnawrq Month Dow <br /> Year <br /> N <br /> 1A.Olacrepa xy <br /> F Indication Space <br /> A <br /> C <br /> 2D.Facility Owner ar Operator,Csr4flretloi of receipt of the wsate materials covemd by tNs rtlartfleet.9x"PI as noted k i ltem 19. <br /> L <br /> T Printecb'Typea Name Dato <br /> y sa r`�re M1tonMr Day Yew <br /> CS14 0=2 LABUIPASTWO(800)d21z9oa.. .labcIrnwer.00nl <br /> u4GO�MM <br />