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i NON•WAZARDOUS 1.GerieratorlD'Number. 2�ageIof 3r Emergency Response 4.1NalsteT{ackingNumber <br /> WASTE MANIFEST <br /> zr v ...5 M -f' _ h.16^41tr'1."7T+74.4 410 it a jt r �.._ <br /> S.Generator's Name and Mailing Address �s Generarors Ste Address(if different than mailing addrese) <br /> 1;A.L`RIAfIS 1-#R,!r il�htpr10- IC Tiib i�AlNtF-ArAiqrE- <br /> 2015t~AAS'SOR3'tS�',l�,. tlid� 1W Sfk-Ei <br /> Generato�s�Phone• �aT�'�1{`3`�.�'� <br /> 6.Tranrter 1 Com aName <br /> r U.S.EPA ID Number <br /> 1`.:ia l',' t�'..r=.Ir,itIi7,rF,.aCi.4't;t...' t�'lf '`.. t+ft'^� •�..- A t-- M. <br /> - 7.Transporter 2 Company Name _•. . V.S.-EPA ID'Numben <br /> 4 8.Designated Facility Name and Site Address( U.S,EPA ID 14umber, <br /> �.. SuiSUN t i'TY CA-19-42, - <br /> { Facili 's Phone 70-1 412 4VS <br /> a 1b Gontalnes 11 Total 12.Unit ' <br /> { 9..Waste Shipping Name and Description -' <br /> t. No .._Type Quantity Wt.Mol. ` <br /> 1'l�lS.fyd�}f I �:ri��!tp/`»'f r` i�r 't 'I; .VIA <br /> .• � r#F1Jl�`r'{"r���'S?�i.i�w�•� :. t r� �.•y ♦ ,..per.i .. QJ) .q. <br /> LU 2 <br /> t t <br /> jj 3. r` <br /> r. 4., c <br /> t <br /> .13.$�p�ecia}l�Handling <br /> yInstructions,and <br /> AAddditionnalInfoorrm/ation5 Rpt _ � } y { Y yp M`40B#,p r <br /> r p:..+3:F1 i'1•.3�i'.1FVF'4 �t F.t xd ../Lrf tST "-C L'CATEIR.-A Y�fi2'•I.soy.7Tk"�Cie ' . VO#j_3`��� •�s�44w 1;:t : Fj��{.i4 �7�1�«.�� : �'• <br /> ` C`L�fi7�i.i ia'i't�I�7'-G�.`C+'�i� '�c�I�}9�!#�'.`>:'•i�:�>f�t"�«1:fi�k"', '�'I,�S*� > },�} v�E!3d�L"�'.��'w�Gt�:'.•1 Lf�'�'v F7 Q rl.��Ct�C) +."'Laf�s?st�l.,C� <br /> 14.GENERATOR'SIOFFEROR'S cERTIflcATiON:I hereby declare eontenfs'6f this consignment are fully and accurately described above by the proper shipping name,and.areclassified;packaged ! <br /> marked and labeled/placarded,and are in all respects in proper,6ndit ofi for tran§port.acoording to applicable mtemational antl national governmental regulatons,e <br /> r r r t: Si nature ' Monti Day' '..Year, <br /> Genereror slOfferors Printed�ypeName ' a i 9 . = , <br /> ' �_ JI t. � - tr �t .. J� .f3'Y. "�!^t•/''6t g!, �'t '' .s.. .. y*'• ;W....+^ _ ' <br /> _r 15.International Shipments 1�7 <br /> from U S '-Port of entryiezlt a <br /> fJ Import to U.S.•' Nc., <br /> z Ditte Ieavin U.S.. <br /> Transporter Signature for ex its only): <br /> w 16.Transporter Acknowledgment of Receipt of Materials <br /> t Transporter 1 Printedfryped Name Signaturey, r"'-` Mo th t)8y , Year i <br /> i' N j Month Oay Year. <br /> Transporter 2 Printed/Typed Name 7 • �..! Signature' Y-R a <br /> 2 <br /> 17,Discrepancy + a <br /> 17a Discrepancy indication Space'. �-•—� f f�aNal R2 action, ©.Fall Rejection <br /> Ll.puantily Type ©flesidue < + 1 r <br /> 4 <br /> l :Manifest Referer>va Number • ' <br /> + r 17b:Alternate Facility(or Generator) r' X. tl S.EPA ID Number <br /> t <br /> c rai <br /> Facility's Phone: <br /> 17c.signature of Alternate Facility{or Generator} Month: DyYear ! <br /> Z r <br /> i < <br /> W c° +. n- #" fx - r a,3rt."C8� `t . !. # z#e <br /> i !n 18,Designated Facility Owner or Operator,Cer68c bon at rcgipt of materials covered by fire manifest except as noted m Item 17a c- M !e <br /> i Pnnteffyped Name } Signature Morytt�� $y j ear <br /> 1 <br /> 969-f3LC-O 6 10498(Rev.9109) TRANSFtORTR#2 <br /> i �.�- <br />