Laserfiche WebLink
NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page i <br /> WASTE MANIFEST Document No. <br /> 3.Generator's Name and Mailing Address _DBL <br /> Ntc <br /> 4.Generators Phone( ) L-,3 O'L C <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Stale Transportees ID <br /> 2 B.Transporte fw 37 —3 3 <br /> 7.Transporter 2 Company Name e. US EPA ID Number C.State Transporters ID <br /> D.Tranaporter2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E State Facility's ID <br /> INSTRAT,INC. <br /> 1105 C AIRPORT RD. F.Facility's Phone <br /> RIO VISTA,CA 94571 (707)374-3834 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> TOW Unit <br /> No. Type Quantity Wtivol. <br /> 2Gv cC�1 <br /> Ca b. <br /> Nuao� �wnn <br /> E <br /> R c. <br /> T <br /> O <br /> W <br /> IR <br /> d. <br /> G.Additional Descriptions for Materials Usted Above H.Handling Codes for Wastes Usted Above <br /> O <br /> Q15.Special Handling Instructions antl Additional Information�r Z �vvA 5 Mez� c z cev;, ze ( o <br /> OZ <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fullyy antl accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to tetleral hazardous waste regulations. <br /> Date <br /> Prmtedrryped Name Signature Month Day Year <br /> 17.Transporter 1 Acknowledgement of Receipt of Materials Dare <br /> A PtlntedRypetl Name Signature �j Month Day Year <br /> P SSG r ti Iia 2 �Gr � <br /> o 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Date <br /> Printed? ed Name <br /> T YP <br /> E Signature Monty Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20-Facility Owner or Operator:Certification of receipt of the waste materials covered by this mangest.except az noted in item 19: <br /> L _ <br /> ( I W S'T-(LIvT Date <br /> T Printed?yP, e Signature Month Day Year <br /> v � y cdµ l 1 : 10V-� Z21 -2-11 t5 <br /> F-1402002 IA.BEL0jASTER6(8DD)621i608 Ymwjabelm.1".,,n enq(Ep OaaECVI%Ep VMEe Rev.3/95 <br /> uslrlGsove6w lir( �/ u•n INK <br />