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NOWHMRWUS 1.-Generetor ID Number 2.Page 1 of 3.Emergency Response Ph 4.W aste Trading Number .y <br /> WASH MAMFEST NOT REQUIREJ � �G.'2 <br /> 5.Generator's Name and Wing Address Generators Site Address(If different than mailing address) <br /> 7-EbVen,W. 7 ren$20632 <br /> P.O.Bax 711.Dabs Tom 44 7=1 4827 DeVW Drive,Steddon CA 96207Generator's Phare: 072)82 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> At Flinn *d SOMbbA CAROW14&M <br /> 7.Trarrsporter 2 Company Name U.S.EPA ID Number <br /> 8,DesioyWl <br /> F ra HM Lata U.S EPA ID Number Q�Q "REQUIRED <br /> WM Ponera HU Lane <br /> FaclOWs Phone &d=, 'A <br /> 9.Waste Shipping Name and Description 10.Cathdir>ars 11.Total 1 12.Unit <br /> 140. Type OL iiy WINol. <br /> cc <br /> ZW <br /> W � <br /> O ' <br /> 9. <br /> 4. <br /> 13.Wal Handing Instructions and Additional Information <br /> 1*zr Pura equoWlt VAM hlaroft. vik'vft sertoiemuas PMjedt 74 1 <br /> figs&Mi;axifMte. 24 hour em ingetw l iffltlCftr{8$B}4234M <br /> 14,GENERATORWITEROWS CERTU ICA110N:I hereby dedae that the contents of this consignment are fully and acdkaatey described above by the proper shipping name,and are ciesood,packaged, <br /> marked and We0edlplacarded,and are in all respects In proper condition for irerreporl according to applicable fiamalkmal and national govemmaniatregoldons. <br /> Gareralo'siWeror's PdnbdlW d Name Monih Day Year <br /> f )fi Y�ttk L� �!� e ri r-e k2-t C..�, f •, t'j '. i i L' �'C�.�i'—(.. ( ` l <br /> 15.International ShglrMIB .. <br /> ❑Import to U.S. ❑Export from U.& rt or...�d erdrylexit <br /> Transporler Mure flor exports onlyy Dote leaft U.S- <br /> 16.Transporter Acknowledgment of Receipt of Materials <br /> T spacer 1 Printe0yped Name y�' ff�� Signature f� f j Day Year. <br /> aTransporter 2 PrtrtedfTyped Name Signature'' Month Day Yea <br /> r <br /> 17.Discrepancy , <br /> 17a Discrepancy hndcatbn Space ❑Quatltity ❑Type ❑Residue ❑Partial Rejection ❑Ful Rejection <br /> Manifest Reference Number <br /> r i7b.Alternate FAcW(or Generator} U.S.EPA ID Number <br /> v <br /> i FadArs Phone: <br /> 0 170.Signature of Altemate Facility(or Ganeratorj Morph Day Year <br /> O <br /> 0 <br /> 18.Designated Fac,Tty Owner or Operator.Certification of receipt of materials covered by the manifest except as noted in Item t7a <br /> PdntedlTypad Name -' Signature /YJ�earr <br /> �..•.r'' l.�f f I + '7 <br /> 169-BLC-0 5 11977(Rev.9109) — � 7 TRAtjl POATER 4#2 <br />