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NON - HAZARDOUS WASTE MANIFEST <br /> PROFILE NO S _ <br /> 1 800-458 3036 <br /> 0 BAKERSFIELD ❑ YOLO ❑ PHOENIX <br /> NOTE This form to be In lieu of the Toxic Substance Controls hazardous <br /> waste manifest To be used for NON-HAZARDOUS WASTES only <br /> /.I I\I•y Iv I`/Ir/rF�^�.Y rV AI IV Iy n. 'r/ti �.r tiI IV•V.V A//V N rV h/A/ ►//V N/.I/4/hI/SI•y.►/!\/A�/...V.►.�//V rV ry/./IV N <br /> Name <br /> IZ <br /> 0 Mailing Address __j _ at,-_ <br /> Q <br /> rZ <br /> uJI City/State /Zip ^L': <br /> Z <br /> W <br /> 0 Phone No Contact <br /> M Signature Date <br /> LU THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> H <br /> ul <br /> Waste Description _ o _ G <br /> a - - <br /> 0 Generating Location <br /> U - <br /> W <br /> M Handling Instructions <br /> Quantity j -� J C )BBL C,)GLS C )YDS C )TONS <br /> CONTAINER TYPE C ;]TANK TRUCK C )DUMPTRUCK C ]DRUMS C )BINS C )OTHER <br /> DESIGNATED FACILITY <br /> NAME 4,f.t;` _ v :Y< "i y- ADDRESS <br /> CITY/STATE/ZIP 1 D 11';1 C-T'— PHONE # <br /> Q <br /> Uj MP VACUUM TRUCK SERVICE TICKET# Orv',i!-7 / 2`/ TRACT/TRLR# <br /> O <br /> cc MP ENVIRONMENTAL SERVICES, INC Bin No s <br /> CL 3400 Manor Street Signature �i'.+� '�.�/+ `r+ I'..- <br /> Bakersfield, <br /> !.-Bakersfield,CA <br /> � 93308 <br /> Q 8051393 1151 PIU DATE !�? , Job# - <br /> T <br /> Name � _' �" - ",��f-t•C1"- �_ _A -=siY4;i�s Disposal Method <br /> Address c 7` 7 V ❑Landfill Other <br /> H <br /> --i City/State/Zip <br /> U <br /> Uai Phone No Timeam <br /> © Discrepancy Pm <br /> cn ' <br /> Signature - Date <br /> TRANI;POPTFR Rr LIN <br />