Laserfiche WebLink
ei <br /> Ai q <br /> i <br /> NON-HAZARDOUS I 1.Generalor ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number 7 <br /> WASTE MANIFEST NOT APPLICABLE �j,� I � f <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> r <br /> 51 <br /> XKGerreraWs Phw- - 7 (�G <br /> 6.Transporter 1 Company Name '� 1 U-S.EPA ID Number <br /> I r'�'�I �• Lt vti 4' )i r r l -. NOT APPLICABLE <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> NOT APPLICABLE <br /> a.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECOLOGY HAY ROAD NOT APPLICABLE <br /> 621!1AY ROAD- VACAVILL E, CA�!+58: <br /> Fa s ftrie: 70 67G4718 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12-Unit <br /> No, Type Ouantly WtNol. <br /> 1. <br /> Lu 07 <br /> W <br /> z 2 <br /> W . <br /> I <br /> I <br /> 3. <br /> I <br /> i <br /> 4. <br /> �n 320J - I <br /> 13.Special Handling Instructions and Additional Information JJ��j- <br /> �1 ►�r�Arf�!T <br /> .H A <br /> /3 <br /> 9W-2-2- <br /> 14. <br /> W-2-Z14.GENERATOR'SrOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generators/Offerors Printedliyped Name,, Signature f^j `�` �' Month Day Year <br /> r / ,7 ! <br /> ...r 15.International Shipments <br /> ❑Import to U.S. ❑6cpod from U.S. ! Port of entry/exit: ' <br /> — <br /> Transporter Signature for exports only): I! Date leaving U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed(f yped Name Signalure i Month Day Year <br /> U) i <br /> aTransporter 2 Printed/Typed Name Signature Month Day Year <br /> t- <br /> 17.Discrepancy <br /> 17a.Discrepancy Incitation Space El1:1T e <br /> Quantity Type ❑Residue ❑Partial Refection ❑Full Rejection <br /> Manifest Reference Number. <br /> 17b.Nlemale Facility(or Generator) U.S.EPA 10 Number <br /> a Facitity's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> F <br /> a <br /> Z <br /> I O <br /> W <br /> O <br /> 18,Designated Facl q, Ovmer or Operator.Certification of receip}of maorials covered by the manifest except as noted in Item 17a <br /> Printed/Typed Name Signature Month DayYear <br /> 1. <br /> 169-BLS-C 5 11979(Rev.9/09) �, � DESIGNATED FACILITY'S COPY <br />