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ON-HAZARDOUS WASTE MANIFEST� I �` <br /> Please print or type (Form designed for a on elite 2 pitch)typewriter) <br /> NON-HAZARDO 1.Generators US EPA ID No. Manifest 2.Page l <br /> WASTE MANIFES CAD9A089b995 Document No. $h 1p�sd63 of 1 <br /> j 3.Generators Name and Mailing Atldress <br /> TRACY SERVICE C'ETiTER <br /> 02 E. V12At7T LITIE Rfl +, C.Y, YurE Y.f . Bt�X 930, <br /> 'A, 953;6 �`XTON, CA, 95201 <br /> 4.Generators Phone(2 t�q ) 44215 mar' <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporters ID <br /> Philip We--t Indu--txial Sexviae- ICAR00017 52 B.Transporter l Phone <br /> Boa 321-1030 <br /> 7.Transporter 2 Company Name e. US EPA ID Number C.Slate Transporters ID <br /> D.Transpoder2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> `> "HEMICAL WASTE MANAt T11 ENT, INC <br /> 5251 OLD SKYLINE ROAD F.Facility.Phone <br /> TTLEMAN CITY CA 93239 1 CAT000646113 1800) 2222-2564 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WLNOI. <br /> a. NON PEGULATELI HASTE LYGU L� �� <br /> G b. <br /> E <br /> N <br /> E <br /> R C. <br /> A <br /> T <br /> O <br /> W R tl. <br /> I— <br /> jG.Additional Descriptions for Materials Listed Above p� H.Hantlling tlesfyyv�"{aster Llstetl Above <br /> (D a, G' P 6 'v .1 E} t•T j /dot <br /> Ca <br /> � vac// <br /> 0 <br /> a <br /> NQ 15.Special Handling Instructions and Additional Informatlon �.�. --;L <br /> = ERC# 24 HOUR EMERGENCY CONTACT: S <br /> {8�j--5m??�5§ I+Ieai YLotective Clothing and E-,retaeat : <br /> 105173CA v1.00 <br /> 0 T* 1v00003 1SSP <br /> 16.GENERATOR'S CERTIFICATION:I hereby sanity that the contents of this shipment are fulry and aceuratety descnbed and are In all respects <br /> In proper condition for transport.The malenals described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Pnntedriyped Name Signature M Day Year <br /> T 17.Transporter 1 Acknealedgement of Receipt of Materials Data <br /> R <br /> A Pdnted/TyppralName Signature Month Day Year <br /> SIN V 0 <br /> p 18.Transporter 2 AcI mowiedgement of Receipt of Materials Date <br /> TPdntedrTyped Name Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space - <br /> 1 20. eilityUvnerar raloG Certification of receipt of the waste materials covered by this no st,except as noted In Rem 19. <br /> L <br /> Date <br /> Triot m Sig ;o a• a <br /> Y <br /> CF, ©2002 lAfiEL1'IAAFR� (B00162t-5808 v.•.xilabelmasteccom <br /> I �60lINK <br />