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,"wool <br /> NON-HAZARDOUS 1.C*wraior ID NumberNOT RF 1Emerge 'rdd&g Number <br /> 1& <br /> WASTE MANFEST I <br /> 5.GeneraWs Name and MaTing Aftess Generator's Site Address(V different than mailing address) <br /> Dalai,ez"rian (L20- W Maw VIL'by <br /> VzO(M rmrh�63 US jr-;'a AiMi, <br /> f_4 <br /> facEz"I"Ve, .Cr VMW <br /> (Lza, crrrtt'.��L iQ,V4 <br /> Geriemlor's Phone: <br /> 6,Toe U.S.EPA ID Number <br /> r <br /> M MUM.Pr --18 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.FPA ID Number <br /> MEW C1znyofl 1"androw <br /> 901 BIQ�Vl road s Phone: <br /> FaM&M.CA 94W 925AS" <br /> cilliv' <br /> 10.Containers 11.Total 12.Unit <br /> 9.Waste Shipping Name and Description NO. Type Quantity VAIVOL <br /> cc <br /> Fqa <br /> Nvi ManjdW;�Matle Seid(Sing} I CM Y <br /> w <br /> W, 2. <br /> Lu <br /> 3. <br /> J1 <br /> 4. <br /> 13 Tw—Harding Instructions and Additional Infwriallon <br /> -j-'. RIPRA MW SAM33147�----- <br /> Wur pm1cv'*,t equomwt 040 tMOV, V*Wft Of YGWB" wwro: qw9we7Pre m"12107702 <br /> are a r, . 24 tow enxiaemY nmbef(W)424-CM Pr*d#: 7 -3 CRA; 240M <br /> Cf*' Mbw. IP IN 4 <br /> 4.GENERATORV.OFFEROR'S CIERTINCATION:I hereby declare that the contents of this consignment are fully and'o-ralely described above by the proper shipping name,and are classified,packaged, <br /> marked and labelalplaca!ded,and are in all respects In proper owdition for transport according to applicable Wem=and n <br /> ptiopal governmental regulations. <br /> Generato(st0iferces PrinWTyped Name Signature Month Day Year <br /> 141 <br /> AtS an bMul of SOPUS-J SMnmn <br /> 15.1rilemallanal Shipments FJ Import to U.S, EIEpd from U.S. Port of entry/wat <br /> Transporter S*ature fore only): Date lea vlm U.S.: <br /> cc 16.Transporter Acknoyoledgment of Receipt of MateriaLs 4 <br /> UA <br /> Transporter 1 PrInteNTyped Nam Signature ( Month Day Year <br /> 0 VA-V k1ly, 'D4 9 <br /> z Transporter 2 Pnnte&Typed Name Signature writh my YOU <br /> 17.Discrepancy <br /> 117&Discrepancy Indication Space ❑ <br /> Q.5ty ❑Type ❑Residue ❑P"Fl*ck" Full Refecum <br /> Manifest Reference Number. <br /> 17b.Aftemate Facility(or Generator) U.S.EPA ID Number <br /> Faclilys Phone: <br /> 17c.Signature of Alternate Faciray(or Generator) Month Day Year <br /> Lu <br /> I18.Designated Fanny Owner orOperator.CerhT on of receipt of materials covered by the manilest except as rioted in Item 17a <br /> Printaib7yped Narne 'r� Signature ' ay You <br /> 'rwl< 14-� <br /> 16�81LC-0 5 11877�Rev.'9109j TRANSPISRTER#1 <br />