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I <br />. 1 <br />I <br /> <br /> . <br />NON-HAZARDOUS WASTE MANIFEST • <br />e print Or type (Form (lealonncl foroae on elite (12 plIct) typewriter) <br />NON—HAZARDOUS <br />MANI WASTE FEST <br />1. Generators US EPA ID No. <br />-(..7 . '....'; <br />Manliest I Document No. 2. Pane 1 <br />of <br />Glen eratee Name end Melling Address <br />'Fabians Collisim Cantor Inc: <br />13 AD5- t <br />215N. 11-10,1. Lime. <br />Generators Phone ( ) StildraOri, Ca 9574)5 <br />• Transporter 1 Comperr#44144443 6. US EPA ID Number Stale Transporters ID <br />Arita aqty:01.0hactrir-pi Troroiport, I nr l''' 0 P i) 0 0 0 V A `V A A Transporter 1 9^ <br />7. Transporter 2 Company Name 8 us EPA ID Number 34e- 5t7i,50, <br />State Transporters ID I D. Transporter 2 Phone <br />9. Designated Fadlity Name and She Address 10. US EPA ID Number <br />EIYIRTIM Ckily TM <br />State Facility's ID <br />cik.D'!.:h.YerP416 <br />MO Smith Ave. <br />Na7arlfz, (..."4. 9456Q I C A. D(= f.z e ..1 4 1 g <br />Facility's Phone <br />(510) 70-4400 11, WASTE DESCRIPTION <br />No. <br />12. Containers <br />Type <br />13. <br />Total <br />Quantity <br />14. <br />Unit <br />Wt.Nol. <br />tqCin Tiazardoits. Liquid ( VST at er . S <br />I Ti 9 60 G G <br />E <br />N <br />E <br />b• <br />R <br />A <br />T <br />0 <br />c. <br />i i <br />.-.._. <br />AddlflOnal Descriptions for Materials Listed Abovu <br />1,441frrigr <br />StAi <br />II I-It-mating Dodos lor Wastos Listed Above <br />Special Handling Instructions and Additional Infcrmation <br />Li i... i i ( <\ 97 <br />1111111111i1111411111 Iffilifillt1111411117111/1111111faital' <br />2EpNwEneAr croOnTilneirtTirlarinCvATIO_Ir‘itei mhearteeLzIcse,rileihsecthst Ih <br />ribed <br /> oencgstemntasnVelsirtisarsehilipoutlseuntitcret <br />;) Itulotlindrar hazardousecura <br />dawsacsir <br />regulations. <br />are in all respects <br />Data <br />Printed/Typed Nemo <br />• ',,,,r-- -- - - ci <br />1 Signature Monet Day Year <br />IJ r t <br />(C3 <br />1 <br />(.1hIV <br />I <br />T. )( <br />'IC1 <br />arise d e )i k i re idge . of Rec Witt killeeal IA L. I.--- # C " e 60 V. / ii k R ' A . <br />N <br />_SI <br />Printed/Typed Name <br />_ <br />16..7ransporter 2, Aci449411tifo.1/4 0i2 ler I 1) <br />Signature "--- 1 Month Day Year <br />, ,. ......_.— . , --40 I-1 0 • .. _ P. <br />uatii <br />ri • T <br />g <br />Printed/Typed Name <br />R <br />Signature Month Day Year <br />• <br />. F <br />A <br />0 <br />Discrepancy Indication Space <br />I <br />L <br />Facility Owner or Operator; C ertification of receipt of the waste materials covered by this manifest. except as noted In item IS. <br />I I Date <br />VI PrtigmdZr1 <br />n Nauss - . <br />.e't N.- -'.:' ' Month Day Year <br />. NI .4%-.... 1 <br /> <br />---, IL C 1 <br />CF14 G:12002 LA1113.AASTOte (8001 621.5858 .www.labolmastercorn