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PROFILE NO. <br /> NON - HAZARDOUS WASTE MA`i41FEST <br /> T NOTE: This form to be in lieu of the'Toxic Substance Controls hazardous <br /> O waste manifest. To be used for NON-HAZARDOUS WASTES only. <br /> B <br /> E Name: ct LL 1A --- <br /> n T <br /> C Address: ------- <br /> O <br /> M City/State/Zip: l>r V�CI�1- ------- - - ------- <br /> L Phone N �j LC> �3 0 / o Cont;:,.,; 3c-p— (Je <br /> E <br /> T THE GENERATOR CERTIFIES THAT Signature ancl d 'a of authorized agent: <br /> E THE WASTE AS DESCRIBED IS 100% <br /> D NON-HAZARDOUS � �0./ §%�� <br /> B Waste Description : T?_ <br /> Y <br /> Generating Location: e CP 4_4�Ie_ <br /> G U <br /> E Handling Instructions: <br /> N / <br /> E Quantity: �� BBL GLS a YDS TONS <br /> R <br /> A CONTAINER TYPE : <br /> T <br /> O TANK TRUCK P'*DUMP TRUCK DRUMS BINS OTHER <br /> R <br /> A UNI-Unlimited Network Incorporated <br /> G 2573 Clay Bank Road, Suite#7 <br /> N Fairfield, California 94533 <br /> T (707) 425-7716 <br /> R Name: I <br /> TICKET# TRACT/TRLR# 7 <br /> A <br /> sAddressBin No's <br /> P 61 <br /> O (t <br /> T City/State/Zip:�,o1(iy "h�y Signature:— — <br /> RI-, Date:t : j I _L� j !I/46/1Phone#�D� / tS�� _�� DateT - <br /> DESIGNATED FACILITY: <br /> T /��_f� <br /> S Name: e11�1C�O-- ---- — — Address:A-71-7_6cc&_CAU_ <br /> D <br /> City/State/Zip: i l _ C tC�' ' <br /> ���� Phone # <br /> F Discrepancy: C <br /> A <br /> C Disposal Method: <br /> L O Landfill Other _I�-f,LC'CE�— — Time:— am/pm <br /> I <br /> T <br /> Y Signature : Date: <br /> While-Gonoralor Relain Yellnw-TranShortnr Rnlain Pink-Facility Retain Gold-Agnnt Retain <br />