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NON AZARDOUS WASTE MANIFET <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS I.Generators.US EPA ID No. Manifest 2.page 1 <br /> WASTE MANIFEST Document No. V 004.43-01 <br /> Of <br /> GiEBgloPs Wama and Mafling Address <br /> 4930 1WC4F?en=St <br /> Stoda:al, CA.9SM3 <br /> 4.Generator'S Phone( 447-10065. ' <br /> ns eCrpt span Name GAZ TRAI�TSPORT,INC s .CAR U P�V]4C3 r A State TransporteP5 10 <br /> $,Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA 10 Number C.State Transporter's ID <br /> D,Transporter Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA fO Number E State Facility's ID <br /> FIrgrem Oil,Inc. <br /> ISM Sn-Ath Ave CAD 990 897 418 <br /> e m-k,CA 94560 F.Facifity s Phone (510)795-4100 ? <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WINaI. <br /> a'NmHazardous' Waste,Liquid(Water) ��- � <br /> 1 DF �C) <br /> G a b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R d. <br /> JJ MIJn <br /> G.Additional Descriptions for Materials Usted Ahove H.Handling Codes for Wastes Usted Above <br /> X: <br /> 15.Special Handfing Instructions and Additional Information <br /> C \ x ��C — �C71. <br /> z -J <br /> z i <br /> Aff <br /> x <br /> 18.GENERATOR'S CERTIFICATION:t hereby certify that the contents of this shipment are fully end accurately described and are In all respects <br /> In proper condition for transport.The matenals described on this manifest are not subject to ederaT hazardous waste regulations. <br /> Date <br /> tetilTyped Name a �/j,J, <br /> CC M1lanfh Day ar <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R Date <br /> A- Printedrryped Name I to <br /> Month Day Year <br /> N <br /> P " f <br /> p 18.Transporter 2 Acknowledgement of Receipt of Materials Date j <br /> TPrinted/Typed Name Signature Month Day Year <br /> R <br /> 19.Discrepancy Indication Space ,1 <br /> A <br /> C <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest.except as noted in item 19. <br /> L <br /> Date <br /> T Printed/Typed Nam Signature <br /> Y a1/1 }l 1 _ Month day Year <br /> tRLSCU� i.7 Oct <br /> CF14 L2002 11.6Et]"(ASIFR0 (t100)621-5808 vnww.laoelmaster.tam ®Awr+cownEcuro�wrn ri <br /> us.mw•ecw� l�Fi i K <br />