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I <br /> { NON-HAZARDOUS 1.Gene Wr ID Number 2 Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT VPUCABLE 15,1806 <br /> t 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> /- ; <br /> I Generator's Phone: ?�t7� � 6' ;� VG �� QC_ <br /> I 6.Transporter 1 ComparryNww <br /> f A, t U.S.EPA ID Number <br /> j! NOT APPLICABLE <br /> j 7.Transporter 2 Company Namer <br /> L. U.S.EPA ID Number <br /> NCrr APPUGABLE <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECOLOGY HAY ROAD NOT APPLICABLE- <br /> 13-42614AY ROAD - VACAVILLE-, CA 9W7 <br /> Facili s Phone: C/O 71 t37&471 m <br /> j <br /> 10.Containers 11.Total 12.Unit <br /> 9.Waste Shipping Name and Description <br /> No. Type Quantity wuVol. <br /> 1 <br /> O <br /> LU 2. <br /> 0 <br /> 3. <br /> I <br /> 5 <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> 1 <br /> I <br /> 14.GENERATOR'SIOFFEROR'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 /> markad and labeledrplacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations. <br /> Generators/ofleror's Printedryped Name i Signature �� Month Day Year <br /> ri 15.International Shil*nents <br /> ❑import to U.S. ❑Export from U.S. Port o(enlry/owl I <br /> Transporter Si nature for exports only): Date leaving U.S.: <br /> ir Lu <br /> 16.Transporter Acknowledgment o1 Receipt of Materials <br /> ¢ Transporter 1 Printed/Typed Name Signature �� Monm Day Year <br /> i' <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 11 a <br /> F <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity El Type ❑Residue ❑Parfial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 171,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facility's Phone: <br /> L 17c.Signature of Altemate Facility(or Generator) Month Day Year <br /> F_ <br /> z <br /> I � <br /> N <br /> W <br /> O <br /> 18.Dosgnated Facility Owner or Operator.Cetfication of receipt of materials covered by the manifest except as noted in Item 17a - <br /> I PrintedrTyped Name Signature / Month Day Year <br /> j <br /> 169-BLS-05 11979(Rev.9/04) DESIGNATED FACILITY'S COPY <br /> I <br />