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r - NON -HAZARDOUS WASTE MANIFEST <br />W <br />Cn <br />(/) <br />0 <br />0 <br />cc <br />a <br />N <br />Q <br />Z <br />0 <br />Z <br />Please print or type (Farm designed for use on elite (12 pitch) typewriter) <br />CFtd C>2002 LABELT"IAS7FAD (800) 621.5808 vrwvrJabelmaster.com5.1 licVllvu� <br />NOWHAZARDOUS <br />1- Genferai'sto�r',as�U`S';EPA ID No. <br />Manifest <br />2, <br />Page 1 <br />4� <br />(� 1kt 6(XJ } r �? <br />Document No. <br />I` < l { . <br />WASTE MANIFEST <br />i <br />of <br />3. Generator's Name and Matting Address <br />Port of Stac kkit) <br />2201 WasIdniahn Awls <br />---- <br />Sfarltnnli CA,95201 <br />4. Generator's Phone <br />5. Transpo or 1 Company Na „ a 6. <br />US EPA ID Number <br />A. State Transporter's ID <br />�rlcelc Chetyllt�l iramotat-t Irm '. i8V1 <br />4.'t1%t34iO(}'lii`40 <br />iPhone <br />B.Transporter <br />7. Transporter 2 Company Name 8. <br />US EPA ID Number <br />C. State Transportsr's ID <br />D.Transporter 2 Phone <br />9. Designated Facility Name! and Site Address 14. <br />A9wttced ChclaTtfral �'�ynupati, Inc. ttvl A) <br />US EPA ID Number <br />E. State Facilitys ID <br />+�_r1x..(100336415 <br />v <br />4 <br />265 P+1��g 1%+ hN" <br />F. Facility's Phone <br />_ <br />tirt`if5:3rti <br />��_,7...J7 �u <br />c , <br />11. WASTE DESCRIPTION <br />Containers <br />13. <br />Total <br />14, <br />Unit <br />t•la. <br />Type <br />Quantity <br />WI.Nol. <br />M <br />ff FF SS1,rr+py tt,,��qq �,rr Y{ {{ss AA qq ) t �� ��_�yS �`` q rr 11 {e'}y `` gg rr,�7 <br />t, ON lJi3'��+ LiYSGULi'i�� HAD �'i AtE dii�t;'1, UQUID tA(,s�JV'14512) <br />NON <br />({p <br />1 <br />Ca <br />b <br />E <br />N <br />E <br />R <br />A <br />T <br />0 <br />R <br />d. <br />G. Additlanet Descriptions for Materials Listed Above <br />H. Handling Codes for <br />Wastes listed Above <br />r4fi} ed N(itt''iblit{r G 1456 <br />15. Special Handling Instructions and Additional Information <br />16. GENERATOR'S CERTIFICATION: i hereby cortity that the contents of this shipment are full yy and accurately described and are In <br />all respects <br />In proper condition for transport. The materials described on this manifest aro not subject to federal hazardous waste regulations. <br />•s <br />` <br />Date <br />printedrTyped Name <br />Signature I 4 <br />Month <br />Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />R <br />A <br />Pdmed<?yped Name <br />Signature <br />Month <br />Day Year <br />IN <br />P <br />0 <br />18, Transporter 2 Acknowledgement of Receipt of Materials <br />Data <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month <br />Day Year <br />E <br />A <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 />Date <br />T <br />Printod/Typed Name <br />Signature <br />Month <br />Day Year <br />Y <br />