Laserfiche WebLink
NO N useon elite(12 pitch)typewriter) VU5 WASTE15T <br /> wASTEA�R�O�s ,.Generalor's US EPA ID No. MANIFEST <br /> Generator MANIFEST <br /> N®me end Nailing M Address <br /> Monilest 2.Pogo 1 <br /> 10:20At <br /> �APARDocument No. <br /> K 4 At l �`INC MARtS Of t <br /> tlt�i <br /> d. enerator's Phone( <br /> 5.Tran ;: ) -A <br /> sporter 1 Company Name 41).r+ <br /> Q'L'f`t�y e <br /> "7Tr�sP�-Ite - �',�t ; 6 �Ar) <br /> S EPq ID NumberA.Slate Transporter's ID <br /> ompany Name ti +y eM �l7 I V .y w B.Transporter 1 PhoneUS EPA ID Number li C.State Transporter's ID <br /> 9.Designated Facility Name and Site Address D.Transporter 2 Phone <br /> R*wto, LAIIU '11_L tg- US EPA ID Number E.State Facility's ID <br /> 3675 MTRE ft LANE <br /> CA F. Facility's Phone <br /> t 1 WASTE DESCRIPTION '- aib�'S);.1 t1!J 3 9 <br /> 12. Containers 13. 14. <br /> Total Unit <br /> a. No Type Quantity Wt.Nol <br /> �t}M ti�17A�tt]Itjl1S!1(7[t1E?t'�llNFt'' <br /> b. <br /> c. <br /> d. <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 15.Special Handling Instructions and Additional Information <br /> A—T (7,H tatTPFC' 1 f ,i`14Q J017'r tie d '4'f f1 ,.t: i 31 #'## #'�t'T ti1''#"# «#'i to## <br /> ,r-'r+r-:;3fi AI.. t'"ROW(Aft <br /> - - - - - - - AV - - - - - - - - - AN <br /> 16.GENERe T oRTIC <br /> dit CERTIFICATION: <br /> transport.The hereby <br /> described othatthe n tents this manifest are not subjectment lto federal and and state hazardous waste re are in lgulationss <br /> n prop <br /> Date <br /> Printed Typed Name Signature Month Day Year <br /> 17.Transporter 1 Acknowledgement of Reciept of Materials Date <br /> Printed Typed Name Signature yy� '' Month Day Year <br /> 18.Transporter 2 Acknowledgement of Reciept of Materials Date <br /> Printed Typed Name Signature <br /> Month Day Year <br /> 19.Discrepancy Indication Space <br /> zu.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> Date <br /> Printed Typed Name Month Day Year <br /> Signature <br />