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NL.. --HAZARDOUS WASTE MAS' ..=EST <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. <br /> NON-HAZARDOUS <br /> WASTE MANIFEST qDocument No.1 o o :� <br /> 3.Generator's Name and Mailing Address 0A i I ARC11 <br /> sf <br /> 16 kI.ANT IRARDFOG, PA1.4-01, CA t <br /> 71 WIT-fl III! f A 9 1i rt �s <br /> rat hone <br /> 4.Generators <br /> 5 5 <br /> Tr po <br /> Transporte,71 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> UVIII'l )NOV f.01 1119"Cof;f1f. !;91 <br /> It 11 3t " % V j B.Transporter I Phone GAAJ -64 <br /> 1 7.Transporter 2 Company Name 8. US EPA ID Number <br /> C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number <br /> E.State Facility's ID <br /> Mlit OAv_ ROAD <br /> V PAY l (074k F.Facility's Phone <br /> If 1 7:r' ti) I <br /> PR. 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> a. <br /> b. <br /> N <br /> E <br /> R c <br /> A <br /> T <br /> 0 <br /> R d. <br /> G.Additional Descriptions for Materials Listed Above <br /> H.Handling Codes for Wastes Listed Above <br /> Cl) JAA <br /> V <br /> D V) <br /> 0 TIC.? <br /> N 15.Special Handling Instructions and Additional Information <br /> < .6w.1Cgel'uZy (w'n)6_44 <br /> 100-4hlff POID 041 -344iih <br /> 2i <br /> 0 <br /> Z <br /> AW AV AV AV F-A KANE" <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Printed/Typed Name Signature Date <br /> 1) 01111-ARD PVT hillf.A.) Month Day Year <br /> 112-71c, <br /> TR 17.Transporter 1 Acknowledgement of Receipt of Materials -q Date <br /> A Printed/Typed Name Signature <br /> N Vb Month Day Year <br /> S A <br /> V. <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> Date <br /> T Printecirryped Name Signature Month Day Year <br /> E <br /> 19.Discrepancy Indication Space <br /> F <br /> A <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 <br /> I Signature F— Date <br /> T Printecirryped Name <br /> Y Month Day Year <br /> CF14 2002 LABELAAS 0 (800)621-5808 —w.labelmaster.corn <br />