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NON-HAZARDOUS WASTE MANIFESTWj0L70S0.,l <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Manifest Document No. r 2.Pagel <br /> WASTE MANIFEST caDys�sssays hip05013 of 1 <br /> 3.Generators Name and Mailin Address <br /> I... ',. CY SERVICE , LATER <br /> 02 E. URA14T LINE ROAD, TRACY, zu8LP.O. BOX 930, <br /> 'A, 95376 STOCKTON, CA, 95201 <br /> 4.Generators Phone('Z09 ) 9421566 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A State Transporters ID <br /> Philip Weet Industrial Servic�ee CAR000177S27 B.TransportarlPhone (800) 321-1030 <br /> 7.Transporter 2 Company Name e. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Andrade 10. US EPA ID Number E.State Facility/s M <br /> €. SMIICAL WASTE MANAUMIENT, INC <br /> 35251 OLD SKYLI14E ROAD I.FadniysPhone <br /> TTLEMAN CITY CA 93239 CAT000646117 {800) 222-2564 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No.. Type Quantity WWol. <br /> NON REGULATED MATERIAL, (USED BATTERIES NI,=L CADMIU14 <br /> DRY) <br /> 001 DM 1 P <br /> C' %ON—REGULATED MATERIAL (MONITORING WELL NATER.) <br /> E <br /> N 007 DM 003851 U <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> R d. <br /> W ,> <br /> N <br /> Q� <br /> H.He 11 Codes for aster Move <br /> ove <br /> G.Additional Descriptions for Materials Listed Above <br /> ® -�hZ2 <br /> N 15.Special H Zing lnsWctious and Atlditionall olmallon 5 <br /> _ ) P4#L 1000 036653; E :u# 154; b) PO#LI: 10000036653; Ebi;# <br /> Z Near Pra eCtive Clothing and Ejecaeat; PO#Trane: 3500760514-17; PWIFILE: (1) <br /> IN0000( 782 .02; (2 8501 v1.01 <br /> z � 1 l�o � s _ r� 6r4) 1, -cc) Cu1»}aLE `6 � ). . 5 � � . Z (� G `1 <br /> tc16.GENERATOR'S CERTIFICATION:I hereby coolly that the contents of this shipment are fulry and accurately described and are in all respes <br /> in proper condition for transport.The matenals described on this manifest are not subject to/ecent hazardous waste regulations. <br /> Date <br /> Printed/Typed Name Signature Month Day Year <br /> 3Zu C«ieG �FmR ® zr Icy <br /> T 17.Transporter 1 Ackuwrvle gement of Receipt of Materials Date <br /> R a Month Day Year <br /> A edRypetl me <br /> Na <br /> IS <br /> IS to op Ck Al 10 a <br /> P <br /> p 18.Transporter Acknowledgement of Receipt of Materials Dale <br /> R <br /> T PdntedrTyped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> 20. ality,Orer r Operator,Certification of receipt of the waste materials covered b 'est,except as noted In item 19. <br /> ' Date <br /> T 6 Na. <br /> Y <br /> CF ®2002 U6ELMASTR' (600)UI-5880.w;rrv,labelmaster.mm 'LLr�mav°:"F"� Q. <br />