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NON,10HAZARDOUS WASTE MANIFES <br /> :Please print or type' (Form designed for use on elite(12 pitch)typewriter) <br /> 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> NOWHAZARDOUSDocument of <br /> WASTEMANIFEST <br /> 3.Generator's Name and Failing Address <br /> P FIC <br /> ACI <br /> LFLTRIC W_ <br /> 502 E Q AN LINE Im <br /> TRAM-Y CA 956 <br /> 4.Generator's Phone((92511513-4846 <br /> 5.Transp rter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> B.Transporter 1 Phone. <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.7ransporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> T�i 08 <br /> M <br /> F.Facility's Phone 40 T W , AL , <br /> FJ <br /> CA 9491 -01- R K <br /> 1 S "D <br /> 12. Containers 13. 14. <br /> 1.WASTE DESCRIPTION <br /> Total Unit <br /> No. Type Quantity Wt./Vol. <br /> a. NON . K1-% (NON HAYARDWS M&TFzRJAJ , <br /> D T 0 0 1, <br /> G b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> O <br /> R d. <br /> W _ <br /> F- <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> p <br /> ww <br /> -A00 UYk 6(,1 <br /> J"1`7 <br /> Q . <br /> N 15.Special Handling Instructions and Additional Information <br /> 877-577-2,M 2020 <br /> E : �� ICP <br /> O �� �, a <br /> AMAWAFAWAFAVAMAW �AWA��W�AWAWAwAw <br /> 16.GENERATOR'S CERTIFICATION:I.hereby certify that the contents of this shipment are fully and accurat y described and are in a I resp s " <br /> in proper p ro er condition for transport.The materials described on this manifest are not subject to federal haza us waste re Mations. ,e, <br /> Date <br /> Printe a Sig , <br /> Month Da Year <br /> A <br /> T. 17. ,ansporter 1 Acknowledgement of Receipt of Materials X�,,:. <br /> R <br /> A inted/Typed Name Si atuPC( on< Day Ye <br /> �� <br /> r _AA4 <br /> rr a '•. 1,SQ_ <br /> IS .. i..r kT <br /> � � <br /> 0 18. Qsporter 2 Acknowledgement of Receipt of Materials Date <br /> � <br /> RPrinted/Typed 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 Printed/Typed Name Signature Month Day Year <br /> Y <br /> PRINTED ON RECYCLED PAPER r ♦pIMTED WITN. <br /> CF14 <br /> c 2 (.MASTER® 800)621-5808.www.labelmaster.com USINcsOYeEM'1W l SOYINK <br /> a 20o itABE <br />