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WHAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter)NON-HAZARD1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> D- 9 0 8 Document No. ,� of . <br /> WASTE MANIFEST <br /> 3.Generato?s Name and Mailing Address <br /> Y� 2 tW M UNE RCAD <br /> �. RAC ,5376 <br /> �"�"` 4.Generator's Phone 925 513-4845 <br /> 5t Transporter 1 Company Name 6 US EPA ID Number A.State Transporter's ID <br /> ,'I A/ B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> j D.Transporter 2 Phone <br /> r <br /> 9.Designated Facility Name and Site Address ', 10. F'. US EPA ID Number E.State Facility's ID <br /> W LUMFILL <br /> .0840 = MNT F.Facility's Phone <br /> - 2 800/449 <br /> LIVEMRE, CA 94%, 1 IC A, D 9 8 1 3 8 2 7 3 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. <br /> MON RgGU1.k&TRD 1WrMJAL (NON HAZ&P=8 GOIL) <br /> cs.. <br /> b• <br /> E <br /> R C. <br /> A <br /> (R d.. <br /> CA Vj <br /> G:Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> ca. <br /> :: . x.0231 <br /> 9.W7 <br /> C)o <br /> oc <br /> ' sYi11 <br /> a <br /> - <br /> 3 <br /> 15.Special Handling Instructions and Additional Information <br /> Gl24 MUR -�- 09a5 <br /> x.02 <br /> SITE 1. <br /> _No <br /> _ _ ,; AW <br /> i lyr1} "'^ S.. r i. 1. s R_ l .per.. <br /> —W A—�u <br /> --n <br /> � f- <br /> ff- <br /> I <br /> 16.GENERATOR'S CERTEFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respectsOm <br /> y in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> y <br /> Date <br /> Printed/Type Signa e: Month Day Year <br /> is e ` <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R Month Day Year <br /> A Print yped NameSignature, <br /> S <br /> PI Date <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/T'yped.Name Signature Month Day Year <br /> T <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <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 Date <br /> T PrintedfTyped Name Signature Month Day Year <br /> Y <br /> PANTED Pia <br /> �F14 ©•2002 LAjREAA5TER® (800)621-5808.ww .labelmaster.com USING SOYBEAN I« ►pYTED WITH <br />