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NON - HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designei I for use on elite ( 12 pitch) typewriter) <br /> 1 . Generator's US EPA ID No. 2. Pae 1 <br /> NOWHAZAR OUS Manifest g <br /> Document N <br /> WASTE MANIFEST <br /> t y CP �7 of 1 <br /> 3. Generator's Name and Mailing Address '� <br /> 40AERAL WF f N r�i0100RS DBA CJ'aBRAL 0HRrF LErR JEEP <br /> CA <br /> 8284148 <br /> 4, Generator's P�one <br /> 5. Trar,,s eke 1 Co�)gar?y, I�ae� e e rye g r . y, F 6. �� US EPAJD Nurrerg i w A. State Transporter's ID <br /> y d Fal - iF . x tit aha .; 4G-5r.. .�JE5'c�flCES 0.r A � � a L ! � i 1 '� .� x;: B. Transporter 1 Phone <br /> 7. Transporter 2 Company Name 8, US EPA ID Number C. State Transporter's ID <br /> D. Transporter 2 Phone <br /> 9. Designated Facility Name and lite Address 10. US EPA ID Number E. State Facility's ID <br /> P (rfPtER,O . I1.LS 3..! $a�' i� r3f..1n <br /> I 7- a'ye, try 1 +-4. :'. ' <br /> :a� y r e- ��� Rr�.'�a r'� T,1. .> �,.�zrj � F. Facility's Phone <br /> ; aIi; Ug � N�] CITY t; S cp ,�1 �C f� �f 0.8 a$ J �'� SYS 6F3 4107 vv2�z642r <br /> SUISUN FTSE �Arw9ia <br /> 11 . WASTE DESCRIPTION 12, Containers 13. d 14, <br /> Total Unit <br /> No, Type Quantity Wt.Nol. <br /> a. <br /> G b• <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> W <br /> R d. <br /> H <br /> N <br /> aG. Additional Descriptions for Mat rials Listed Above H. Handling Codes for Wastes Listed Above <br /> 5 WOES Ti RM' 1i'G`,en DIXON & ,W PHIS-r— —00 <br /> D <br /> ccQ <br /> N 15. Special Handling Instructions nd Additional Information t <br /> tin rT C 1 i'��Tr` . '� .. 0 3 US PPE <br /> Z ! `E .� 'cP a st ,l Ri `r; 1a�Y 1t �INTt , CA 9547 <br /> WAN ® W ® ® <br /> 16, GENERATOR'S CERTIFICAT ON : I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transpo . The materials described on this manifest are not subject to federal and state haiardous' waste regulations, <br /> s <br /> Date <br /> Printed/Typed Name..^ Signatur,'e ; 1 q d`; Month Day Year <br /> AS <br /> T 17. Transporter 1 AcknowledgemE nt of Receipt of Materials A ,F - Dale <br /> R <br /> PrintedfTyped Name Signature / Month Day Year <br /> S /A ;� � <br /> p 18. Transporter 2 AcknowledgemE nt of Receipt of Materials Date <br /> R Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 20. Facility Owner or Operator; Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br /> L Date <br /> E T Printed/Typed Name Signature Month Day Year <br /> Y <br /> E <br />