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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed'or use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1 Generators US EPA ID No. Manifest 2.Page 1 <br /> Document No. <br /> WASTE MANIFEST I Of <br /> 3.Generator's Name and Mailing Address t"' „} <br /> 2-�}�� ��A-tuT N�-Y �r ua r •O �� �rJV i 2cs�vpr�. <br /> 4.Generators Phone <br /> 5.Transposer 1 Company Name 6. US EPA ID Number A.State Transporters ID <br /> 17y- 5 4f 1-v.,(� f3.Transporter -7 (� <br /> �.Transporter 2 Company Name 8. US EPA ID Number C.State Transporer's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> qamwala <br /> � <br /> 1=C!'V17"Wf >t'Mi. F.Facility's Phone <br /> FAQ V61A,CA 94571 t_fln 374,B3a <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. I Type Ouantity, W11vol. <br /> t U A Z.A t20oo W A- C(Z- <br /> G b. <br /> E 4 <br /> N Psrr- �-1A-Z./-1 2-pc7V S -b2r Ikeo i � _. t <br /> LyE <br /> R <br /> A <br /> T <br /> O <br /> W R d. <br /> H <br /> U) <br /> G.Additional Descriptions for Materials Listed Above H Handling Codes for Wastes Listed Above <br /> o oma- <br /> cc <br /> 15.Special Handling Instructions and Additional Information <br /> a <br /> r <br /> 1 <br /> z u r <br /> 16.GENERATOR'S CERTIFICATION:I=mortify:hat 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 regulations. - <br /> Date <br /> PnntedrTyped Name S.ignalure Month Day Year <br /> T 17.Transporter 1 Acknowledgement o1 Receipt of Materials _ Date <br /> R Pdntedryped Name s!gnaiure r r • Month Day Y r <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R <br /> T PrintedfTyped Name Sigr+ature Montt Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> 120,Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Pnnted?y a Signature Month Day Ye r <br /> F-14192002 tA6ELAASTER4D (600)621-5808 www.labelmastercomRev. a% <br /> s.Mrn <br /> n INK <br />