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Moue prink or type <br />NON-HAZARDOUS WASTE MANIFEST <br /> (Form designed tor use on &Ile ( 2 pitch) lypevd:lsr <br />NON-HAZARDOUS <br />WASTE MANIFEST <br />1. Generator s US EPA 10 No. <br />CAL000415264 1 <br />, - <br />Manifold <br />Document No. D311236 <br />2. Pepe 1 <br />, af i <br />3. Generater's Name and krsidno Address <br />MizXan America Inc (fonnerlv R&B Foods) <br />1400 Waterloo Rd <br />Stockton, CA 95205 <br />4 Generators Phone ( )209-761-6800 <br />5. Transporter 1 Company Nome O. US EPA ID Number <br />Advanced Chemical <br />A. State Transportere I D <br />Transport Inc/DBA ACTerwirol CAR.000070540 B Transporter 1 Phone doe_ 8_5(SIA <br />7. Transports,' 2 Company Name 8. US EPA ID Number C. Shea Transportarl 10 <br />I 0. Transporter 2 Phone <br />J. Nechako Faddy Hams end See Addresi 10. US EPA ID Number <br />Yolo County Landfilt- <br />E. Stets Facile-ye ID <br />CAC002185849 <br />• 44090 County Road 28H <br />Woodland, CA95776 <br />I <br />F, Faelters Phone <br />.. <br />No. <br />Containers <br />Type <br />13. <br />Total <br />OvanSty <br />14. <br />Lrv! <br />1Art.No . <br />'Non-Hazardous Waste liquid (Water) <br />t TT P <br />G <br />E <br />N <br />E <br />b. <br />R <br />A <br />T <br />0 <br />' <br />U AlclOonal Deacmplions !or Matorloks IJatcri Atcvn H. H4i,x4lip Codes to, Wastes Oared Above <br />- ' 15, Special Handling ln4tructtons and Additional <br />i <br />inl0rMe(kr <br />P (*rot Number 258221 Document #: D311236 <br />1) 2020-378 MW- a\t 0)t .ir (0 3 S <br />--..; <br />,~..- <br />.. ' <br />-, ,... .. .m,---.• . , e.-:.:4. -, .. ,,,,-, , . AI Air alf AV 11111, Alf Alf likal li'V Afii L ,%i4/ .ITY i',4 r, .xi7 t.P.Ar-. ,PW 4., • . i <br />IL OgNERATO191101111T1PIOATION 1 herreby Candy Mel the 00,114M4 01101, shipment ars 107 and ecouraisly described ire are in all 'septets <br />In proper condlion OF Oareport. TN meOrirtela 4.1.002.4 an Ella molls'? Ids nol Jubilee! to Wood hazardoue weak regulations. <br />Lç <br />I Dal <br />Pooled/Typed Name <br />ne.e05 s <br />x8Ignieure „../..4`.. ...........e.,/ Montli Day Yrs, _, 65( I -WI 7_, <br />x 17. Transporter 1 AcknowledgeMent or Poompl ol kratarkes Oars <br />A PrtntaP/Typad Name <br />kgel....., (r‘'',. S <br />(*swum Mpill Day Yoar <br />siArti-fICLF—, kr.--,5.S c ocif 114 1 -2.0 <br />111, Treneporler 2 Acknowledgement 01 R•Palpl of Molertal Dale 11 <br />a <br />Printer:I/Typed Name Sipelor• P.Cvlfh Day Von, <br />I I <br />F <br />A <br />C <br />Discrepancy ,nricalken Space <br />.1 <br />L <br />Penally Owner or OparalOc Cerfilkalion or receipt of Me Will, materlale Waned by lids manliest except as holed In lism la <br />I I Data <br />T <br />Y <br />Prtc Jae • •.., <br />• <br />/lit< <br />Sign <br />CF14 0 2002 LABLAAITER. (800) 821.6808 www.igeolmasier.00m