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NON—HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS1:Generator's US EPA ID Na Manifest 2.Page 1 <br /> Document No. <br /> WASTEwow 8 8 6 9 9 8 <br /> iYfA�fF�S � � <br /> of <br /> 3.Generator's Name and Mailing Address <br /> PTCI F ., GAS &,R J?-CTR -. ' <br /> 502 F ' LINE ROAD <br /> 11 G 76 <br /> 4.Generator's Phone( 9: J. -- <br /> Transporter 1 Company Nam <br /> 6. US EPA ID Number A.State Transporter's ID <br /> B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name B. US EPA ID Number." C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility dame and Site Address 10. US EPA ID Number E.State Facility's ID <br /> f IAOFILL <br /> 10840,AVTAMINT PMS F.Facility's Phone <br /> JJVEW,M- I CA 94901 C A D 9 8 1 3 8.2 7 3 2 fM/4449­&349 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol: <br /> a. <br /> 'Not WaN fl",ARMUS SOIL) <br /> D T 0 1 <br /> Ca b' <br /> E <br /> N <br /> E <br /> C. <br /> A <br /> T <br /> O � . <br /> R d, <br /> LU � . <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> weNON 3 1�� . <br /> 1 <br /> ,r QQOOO, <br /> 15.Special Handling Instructions and Additional Information <br /> Q <br /> 24 HOUR 877-5,77-2669 <br /> - <br /> TAG . <br /> AW <br /> AWA ., AW AW AW AW AW AW <br /> AWAV AW AV ,r <br /> a=. 94 <br /> 1 [A�4 C)+ <br /> 16:GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regale' s. <br /> { . <br /> r� <br /> .Date <br /> ted/Typed Na Sign ur f ,' <br /> Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R Signature Month Day Year <br /> A Printed/Typed Name <,� <br /> N I I V, <br /> L.U <br /> s � <br /> PDate <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> T <br /> Printed�T"yped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <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 PrintedrFyped Name Signature Month Day Year <br /> Y <br /> C 0 2 AASH O 800)621.5808.www.labelmaster.com <br /> PRINTEDUSING <br /> SOY vc�EO P��A�j►��a,Eo wlte <br /> CF14 <br /> O 2 0 LABS � � �s�►,c soveEAw u,Mc �FJ SdY INK <br />