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OCT 292014 <br /> '�-l0 5S <br /> NONHAZARDOUS 1.Generalor ID NumberPage 1 o1 3.Emergency Response Plane 4.Waste Tracking Number <br /> rl <br /> WASTE MANIFEST _ _ —qWR2598-002 <br /> 5.Generators Name and Mang Address Generators Site Address(if different than maling address) <br /> Chevron 90557 <br /> PO Box 6004 — Chevron EMC Waste Desk 139 SO CENTER <br /> CA 94583 Stockton, CA 95202 <br /> 386 6044 <br /> fx Trdnsporlar i ComparTy come U.S.EPA ID Number <br /> 7.Transporter 2 Company ame U.S.EPA kNuunber <br /> � L �R-r✓IG�.S �� �.3 3 <br /> B.'Designated Facility Name and Site Address U.S.EPA ID Nunber <br /> Veolia ES Technical Solutions, LLC <br /> 1704 West 1st.Street <br /> F W-&e:CA 91702C A D 0 0 8 3 0 2 9 0 3 <br /> _ <br /> . ers 11.Total 12. <br /> 9.Waste SNPPT9 No.Name and Description o.ConWhol. <br /> Type Quantity WlNol. <br /> L <br /> RNON—DOT REGULATED MATERIAL (Construction, <br /> g Demolition Debris and Soil, Non—Regulated) O2� VIM XZI(000 P <br /> w <br /> 2. <br /> O <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> 1. Profile# 615562 Wear Level "D" PPE, glovem, 9099le9, splash <br /> protection (if liquids present) <br /> WR2598 I ERG: NA <br /> SO 0 0015155919 <br /> 14.GENEitATOR'S/OFFEROR'S CERTIFICATION:I hereby dadare that the contents of this consignment are fully and accurately descd6ed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledrplacarded,and ere in all respects in proper condition for transport according to appricabie international and national governmental regulations. <br /> Generators/OfferorsPrinled/Typed Name Signal ure Month Day Year <br /> r 15.Internat oral Sh pme xs ❑Import to U.S. ❑Export from U.S. Po of entry/axil: <br /> Transporter Sinature for exports cinl : Dale leaving U.S.: <br /> w in.TsnsporterAcknowledgment ofReceipt ofMaterials <br /> Tr 1 Printed/Typed N S' Month Day Year <br /> S t a n ,',n D 1 Zd <br /> a T er 2 Print yped Month Day Y <br /> �' �— l 1 <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Type ype ❑Residua ❑Pariah Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 17b.Allemate Facky(or Generator) U.S.EPA ID Number <br /> U <br /> rat Facility's Phone: <br /> 17c.Signature of Allemata Facility(or Generator) Month Day Year <br /> z <br /> z <br /> S <br /> w <br /> w <br /> 0 <br /> 18.Designated Facility Owner or Operator.Certification of recelpt of materials covered by the manifest except as ed lift 17a <br /> PrinlWyped Name Sign ra V Day Year <br /> o <br /> 169-BLG0 63 10498(Rev 109) DES16NATED FACILITY TO GENERAT R <br />