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NON - HAZARDOUS WASTE MANIFEST <br /> r <br /> 119 0 8 <br /> PROFILE NO <br /> 1-800-458 3036 <br /> ❑ BAKERSFIELD ❑ YOLO ❑ PHOENIX <br /> r' <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 /> k Name r <br /> O Mailing Address i r <br /> a <br /> LU City/State/Zip I <br /> Z <br /> w <br /> 0 Phone No Contact <br /> 09 <br /> m Signature Date _ <br /> THE GENE ATOR CERTIFIES THAT T ASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> F_ <br /> CL Waste Description MONITORING WELL SAMPLING <br /> U Generating Location <br /> LU <br /> M Handling Instructions <br /> Quantity I ]BBL IX]GLS C ] YDS C ]TONS <br /> CONTAINER TYPE CX]TANKTRUCK C ]DUMPTRUCK C ]DRUMS C ]BINS C ]OTHER <br /> DESIGNATED FACILITY <br /> NAME SRAPO T ENVIRONMENTAL SERVICES ADDRESS 675 SEAPORT BLVD. <br /> CITY/STATE/ZIP PHONE tt 690-164-8154 <br /> cc <br /> ISJ TICKET# S 17 TRACTITRLR# <br /> F- MP VACUUM TRUCK SERVICE <br /> MP ENVIRONMENTAL SERVICES, INC thin No s <br /> CL 3400 Manor Street Signature <br /> k c!J Bakersfield, CA 93308 Date <br /> Z 805 1 393-1151 PJU DATE Job# <br /> � a <br /> is <br /> 11 Name -cFAvo'RT F.1a31TRONJMENT SERVICES _ Disposal Method <br /> ❑Landfill Other <br /> Address <br /> RET)WOOD. rTly, CA 4063H <br /> City/State/Zip <br /> U <br /> ti Phone No h 50-3 4-81 54 Time am <br /> pm <br /> D Discrepancy <br /> 1 <br /> Signature Date / / <br />