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i <br /> -Nb -HAZARDOUS 1.-Genarator�lD NVmb6r - 2.Frage 1 of 3.Emergency Response Ptrone a,Wasta Tracking Numbel , <br /> WASTE MANIFESTa- <br /> 5.Generator's Name and Mailing Address Generators Site Address of different than mailing address) <br /> .357 6111 kvmqbe Arusal�m%C.�+.Ism, k!�s, 7S' I T;� y7F�T <br /> Generates Ptxme#=,231__t" TRACY,CA ' N' Lig}t <br /> '6.Transporter 1 Company Name U.S.EPA ID Number <br /> Fllilard En�1i�-plTientlil'I'arOces C11 33 y'A 3 <br /> 7,Ttansporter 2 Com Name U.S.EPA ID Number <br /> 8.Designated Faality Name and Site Address U.S.EPA ID Number <br /> Os <br /> wv 7Q L ISA <br /> Fadi s <br /> ' 10.Containers 11.Total 12.Urtil <br /> 9_Waste Slipping Name and DaWpeon <br /> No. Type Quantity WWoi. <br /> 1 )'v;'i k x R }�a'a`��tJ� � I��� 1� vU 1�� �eJ t}fit j fu Ft <br /> ic <br /> I¢. . 'rZ <br /> 6c " <br /> 4. <br /> 13.Specht Handing instructions and Additional Intomn'atlon <br /> 19,GENERATORVOFFEROR'S CER'11RCATION:I hereby declare 1W the contents of-this consignment are fatly and accurately dekribed above by the propar'ftpi ng name,and are classified;packaged <br /> i. marked and labelekirplacaznied.and are In ag respeds in pmpar condition for tmnWfi a000rd'mg to applicable imemational and nal+orW governmental regulations. <br /> a GeneratofdMroer P ted7yped Name ACie— o ' sgnatu� t.t`� r d c!�'vl s !'r Month Day Year 1� ' <br /> 21 15.IftmOUVial Shipments / <br /> M ❑ <br /> Expos Impert to U.S. <br /> ❑ from U.S. ✓ Porttr)7exk: <br /> { 3 :Tm er.S' afire for Datefeavi U.S- <br /> W. 16,Trani tler AcfcV*dgment of Receipt of Materials <br /> i cc Transporter i Pr dfS.lped Name,' " Sinw,� Mo Day Year <br /> a. <br /> CO <br /> f 't .Rr 4JAI I <br /> C Transporter 2 Printed/Typed Name Signature Month Day :Year- <br /> 17.Discrepancy <br /> 7a.Discreparxy Indication Space ❑Ouantity ❑Type' ❑Residua ❑Partial Fiejsdian:.'1--':: ', ❑Fuq Rajectk, <br /> M&est Reference Number. <br /> 17b:Aftemate Faa7ily(or Generator) F U.S.EPA1D Number;, <br /> a t=adfily'8 Phone: <br /> 17c.Signature of Alternate Facility{or Generator)' ;._ Month Day Year <br /> Z - •,fes'aa'+, ..:W.:r <br /> 8 � ` s yM -4 � 5 <br /> r <br /> v <br /> a :t .�,'���"� a,+�.� .i�a�°N'„� ��ry}^ r�...�- ��•.r s,s r,xw .� s. �. .� ,��r?: �`�".� "^�-��;w 3rd' ,�` a:'meq�-�' �r' %�"',+�.--.�- .��i' <br /> ,x `*.� � .'�`�. -�. 5 s��;�.:•.�c rhr+-t _�.r `�'�'�a'�"r`w��^� --� c '""^'”' >;'_ `a..'�"'-- ��-E'- '£+'�,eta ��y� <br /> + 18.Des'sgnated Fatty Owner orOperale,CeRification of reoefpt of materials 6&Wged by the Mahifest ggpt.a's'noted In ttem 1 a <br /> r <br /> Prinled/Ty* . S!ig lre "9' t Manch Day �Ye <br /> J _ <br /> 161-8 5 i 77(Rev.9109) f d d �tA70R'S/SHIPI'I:R'S IPIkTIAL COPY <br />