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05/12/1998 06:15 7146705420 EHS ARCO LA PALMA PAGE 02 <br /> NOWHAZAR D 0 U S WASTE MANIFESTWO 20801 <br /> NAME P%"Qh-AQ M <br /> SITE NAMEA rz to (R- i o tj --# <br /> MAILING AQStSS-%vQ1PP SITE ADDRESS -f3-E5 <br /> M 00 ZIP <br /> CITY,STATE (&!RUA PA-6ZAe-) ZIP CITY,STATE <br /> PHONE .-:)p 10 Z-pw PHONE <br /> r-1 <br /> CONTAINER(S):NO. TYPE: Drums Lj Dump Truck Tank Truck Other`-Itti <br /> G TOTAL QTY* UNIT C21 (Describe:) <br /> E WASTE DESCRIPTION. <br /> N <br /> COMPONENTS OF WASTE % COMPONENTS OF WASTE <br /> E 1, 9. <br /> R 2. <br /> A 3 <br /> T 4. <br /> 0 5 13. <br /> R & 14, <br /> 7. 15. <br /> 8. l& <br /> QE;GIENERATOR CERTIFIES THAT WA TEW�SCRIBED IS 100%NON-HAZARDOUS <br /> A <br /> /C;A AT <br /> Typed or Printed Name ignature ate <br /> T PRIME CARRIER Dillard Truckina.Inc. TRUCK UNIT TRAILER UNIT 2: <br /> R Ohm Dilfard Environmental Services_ Bin No(s): 1.) 2.) <br /> A MAILING ADDRESS_P013 579 Scate/Weight Tag <br /> CITY,STATE Bvron.CA zip 94514 J013#- t o0-7 <br /> N PHONE (510)634-6850 PO 0: C 6 c7e <br /> S <br /> P (ALTERNATE TRANSPORTER) <br /> 0 NAME_--- TRUCK UNIT** TRUCK UNIT#; <br /> R MAILING ADDRESS Bin Nu(s): 1.) Z) <br /> T CITY,STATE ZIP- Scale/Weight Tag <br /> PH NE <br /> E <br /> Typed or Printed Na a lure Date <br /> NAME k 1!�!:5 DISPOSAL METHOD- <br /> FACILITY ADDRESS tze---, L. f--- <br /> CITY,STATE­4�,�-kkt-AC;iZIP '611K) I RECYCLE <br /> A PHONE-k5j.0 LANDFILL <br /> C APPROVAL CODE OTHER <br /> RECEIVED 19 Y.- <br /> ---------------- <br /> L <br /> I <br /> T <br /> Typed or Printed Name Signature Date <br /> y ........... <br /> Discrepancy: <br /> (it any) <br />