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NON-HAZARDOUS WASTE NON-HAZARDOUS WASTE MANFEST <br />Please print or type (Form designed for use on elite 12 itchtypewriter <br />NON-HAZARDOUS <br />WASTE MANIFEST <br />1. Generators US EPA ID No. <br />C A L 000368E,,93 <br />Manifest <br />Document No. <br />2 7 4 3 <br />2. Page 1 <br />of <br />3. Generator's Name and Mailing Address <br />INIPERIAL TRUCK AND WASH REPAIR <br />2142 W YOSEMITE AVE <br />4.tliartMone( 209 239_8111 <br />CA .95337 <br />5. Transporter 1 Company Name 6. US EPA ID Number A. State Transporters ID <br />I B. Transporter 1 Phone <br />7. Transporter 2 Company Name a. US EPA ID Number C. State Transporters ID <br />1 13. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />YOLO COUNTY CENTRAL LF <br />E. State Facility's ID <br />44090 ROAD 28H <br />WOODLAND CA S577,3 I CALOO 0 0 7 S 8 8 7 <br />F. Facility's Phone <br />530 6664852 <br />11. WASTE DESCRIPTION ii <br />No. <br />12. Containers <br />Type <br />13. <br />Total <br />Quantity <br />14. <br />Unit <br />Wt.Nol. <br />a <br />NON -HAZARDOUS WASTE, L1Q U it) "SUMP WASTE' <br />G <br />E <br />N <br />.E <br />b. <br />R <br />A <br />T <br />0 <br />c, <br />R di <br />1 <br />I <br />i I <br />G. Additional Descriptions for Materials Listed Above <br />1 <br />H. Handling Codes for Wastes Listed Above <br />Special Handling Instructions and Additional Information . <br />EMERGENCY CONTACT: CHEMTREC 1-800-424-9300WOES TERMINAL Dixon * PROFILE # 981 : 2021-329 *APPROPRIATE <br />PERSONAL PROTECTIVE EQUIPMENT ,------ <br />I <br />iiiiiiiiif filei if illA <br /> ...... i , <br />i 1 ‘1 <br />— - - • . • 411117bed <br />) <br />i <br />' BF M/11////./ <br />GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment are fully and accurately d awndAllirareeriengaulll'artejosnpsects <br />in proper condition for transport. The materials described on this manifest are not subject to federal and state hazardouswaste <br />i Date <br />Printed(Typed Name <br />. <br />-W -r St ( LA (tit M ft <br />I Signature Month pay Year <br />iN C ' I iCii:,' 2--- T Transporter 1 Acknowledgement of Receipt Materials <br />R ...1 ---:, Date <br />A <br />gp <br />Printed/Typed Name r ‹. PPL-T-6 4.-37-- X irlt. 5 <br />I Signs _,..,... Month Day Year <br />.--"7;---;-0--, • . — ,....._.........._ <br />a /El. Transporter 2 Acknowledgement of Receipt of Materials Date <br />R T <br />E <br />R <br />Printed/Typed Name I Signature Month Day Year <br />1 1 <br />F <br />A <br />C <br />Discrepancy Indication Space <br />I 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 Date <br />T <br />Y <br />Printed/Typed Name Signature Month Day Year <br />I 1