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02/07/2006 17: 18 9256340874 DILLARD TRUCKING PAGE 19/29 <br /> NC�i4-HAZARDOUS WASTE MANH-EST <br /> please nont or'i,,rn (Fnnn deslgn9d for u9e on cute(12 aitch)"ewrit9r) <br /> WON-H LAHIJUUS 1.GangraW3 US EPA 10 No. ManNast 2.pig 1 <br /> WASTE MANIFEST C A L O p C 2 2 g 5 5 S DocuMcnI No. of 1 <br /> J.GMorntor'3 Name and Mailing Atldm�: HATL I.i BP MRST CAA QRS+7f1t 'S �•;� <br /> ARS �#59� PU BOX 80249 <br /> gl�E1 !i R2t311�Fl11C 94 RB "APMRITA, CA <br /> 4.09neralor's Phono( _jl.d ,5'7(>' .Ojjol <br /> 5.TQM010e 1 Ccnpnny Nome U5 EPA ID Numbgr A.State Tranaponceg l0 <br /> b T LI. RID 'We I,<a010!%- AL 337,,3 C A n 9 a ti -S 2 3 ,1 3 B.Transporter 1 Phnne .534 f'i1395t.1 <br /> 7.Transpoaur 2 Company Name A, US EPA ID Numbgr C.State Transportor' 1() <br /> _ D.Transporter 2 Phanq <br /> 9.DaSignaigd FgcIIIN Nein and$qe Address t0, US EPA ID Number E.State FeCIHtys ID <br /> W° )ft{rti RAI 'Mr. f."OV I t.i. <br /> F.r-acillty' Phong <br /> f1 n f1 ; 9 0 -1 If '+ <br /> 1+.WASTE DESCRII'rICN +2. Containers 1a. +a, <br /> Total Unit <br /> No. Type Quantity wtNol. <br /> i9 k) <br /> C n. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> o <br /> R �• <br /> Q ' 1 G.ArldiflannI Deacdptbns.Ior Malorial5 Ileal Above <br /> H.HemxllIng Codes for Waetwt I-ie=gd Above <br /> 11b. �1 <br /> :31 ltd. JAN �• �� 2�(jF <br /> Z: <br /> a15.Spedal Hnndnnw)Instuctione,and Additional Inlpm,atlon <br /> I <br /> lett4"14CY C+caua3)6 <br /> tat(9234 -60030 DILLARD <br /> Job � 2 .319 <br /> Z <br /> 18.GENERATOR'S CERTIFICAIWN:I hantby carlffy that the Contents of Mia shipment ans Mtyy and accurately descri led and are in AN rx pgota <br /> In propar condRlon for tranepoA.The nlAtgrtals described on Mie manifest aro not subject to ledersl hazardous wEIBI 3 regulalionc. <br /> + <br /> Date <br /> PnrngdlTyped Name $tgnetura .. Month <br /> DRV Y9ar <br /> TR <br /> 17,TYarlaponer 1 AcknowjadgarneM of Rbceipl of Meterlats <br /> A Pnnte<layped Namo Date <br /> Slgnatare <br /> N Mourn bey roar <br /> p18_Trnnspongr 2 Acknwnedgerwt of Rltcelpl of Materials' <br /> Pfintad/Typed Name Signature Oete <br /> T <br /> EE Month Day Yeer <br /> t9.Discrepancy Indi=tion Space <br /> F <br /> A <br /> C <br /> ( 20.Fftf tty Owner or Operstor,Certification of receipt of the waste maleriafa c&.,aW by MIS menMest,exc0pt ae noted 1.)Item 19- <br /> L <br /> oats <br /> TrP;�yped Name Slgnaturo <br /> Y Mdnn1 Day Year <br /> i <br /> CFIa 0200; IMFiAA&TFxrytado)szt-saoe.vww.meurnaater,eom .. ®�w�q-raio�� —Jn•1 <br /> tr.w <br />