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NON NA2'AR00US f.Generator 1G Number 2.Page t of 3.Emergerrry Response Phone A.Waala 7retktn Number <br /> WASTE MANIFEST N/A 1 ($77)25t�82 5 I '� '�6039-002 <br /> 5 Generators name and Mai ng Address Generators Sae Address(if different alran mOng address) <br /> Paciics Ethanal <br /> 3028 Navy Drive <br /> Gene�VI tr CA 95208 <br /> (2091 86140M <br /> 0 Transporter i Company Name U.S.. EPA ID Number <br /> Ponder Erlvironmerdal Services Ino I CAR000180737 <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 6 Designalad Fapl'ddyy Name and Re Address U.S.EPA Il)Number <br /> Patrero Hiits Landfill <br /> 3076 Patrem Hills Ln <br /> Suisun City, CA 94585 <br /> Fealty's Phone (707)432-411122 CARt7MOM158 <br /> 9 Waste Shipping Name and Description 10 Containers 11 TOW 12.Urat <br /> Na Type Quantity W1Nd <br /> ! <br /> Non-hazardous waste, figuid(rinse water) 001 TT �� Q <br /> w <br /> W <br /> as , <br /> 3. <br /> ! <br /> d <br /> i <br /> 13.5peaal Har>d#.'ng lnstmews and Additional Iniw=Wn <br /> Proffle PHLF 17-137 Truck##, <br /> Job#17-10039 <br /> 14,GENERATM'SOFFEBOR'S CERMCATIOK l hereby dednrs that the contents of this cwrrstgnment are fully and acarrately described above by the proper shipping mase,and are classified,packaged, <br /> Marked and labeledlptacarded,and are In all respects In proper Candrdon for Ira WA axordiing to appikabie international and na%nal govemmA mal regutations. <br /> GeneralorstOfferces PrinteOyped Name Signa re Month rosy Year <br /> 15.International Shipments <br /> ©Impart to U.B. ❑Ezport from r.5. Post 01 entrylexil <br /> Tra=var Sizna ure ifor exxaas i=" pate leaviv Us <br /> s 16.Transporter Aclmrowied finent of Receipt of Materials <br /> Tnarrspw"° dntedfT Name Slgnalure Meath Day Year <br /> r 3117 <br /> ZTransporter 2 Pdrdadlfyped Name S'rgneture Moruh Day Year <br /> 17 Discrepancy <br /> t7a.Disaapancy Indication Space ❑I]uent ty ❑Type ❑Residue ❑P,w Re(edron ©Fug Aejediwn <br /> Maddest Reference Number 17b.Alternate Faafiy(or Generator) U S.EPA ID Number <br /> v <br /> E, Rob a Phone _ <br /> G 17c 5 9nature of Agemate FacHity(or Genmalor) Month Day Yew <br /> s <br /> Z <br /> a3, <br /> w <br /> a <br /> tfi.Designated Fitly{}weer or OpemjCerbT1A101pfmatadafs covered by the manliest except as noted&1 Item;191 <br /> PrintedfTyped Name Signature Month ey Year <br /> — L 1 117 <br /> 169 8LG0 5 11977(Rev.9109) DESIGNATED FACILITY TV GENERAT R <br />