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NO"AZARDOUS 1•Generator ID Number NOT REQUIRED 2.Page 1011 3.Ernef gene° .00 4.Was1e7Fad drag Number 214702 <br /> WASTE MANIFEST <br /> 5.Generators Name and Medirrg Address Generates $'o Addrw(d di went than maBV address) <br /> Shell 08 Products US cto CRA,Attn:Derek Ellman 4315 Waterloo Road <br /> ON Corporate Daft,11riftFISP01115.IN 48278 Stockton,CA 95205 <br /> GenereWs phone 317-291-7041 <br /> "T m 1 a grated Servioes,Inc. U.S.EPA ID Number CAR000148338 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S DaValed Facdy Nye and Site Addrew U.S.EPA ID Number <br /> Kefler Canyon Landfill <br /> 901 BaDey Road Not Requfied <br /> FardTill s Phone: ksburg,CA 945th 925-458.9800 <br /> tO.Contehnas 11.Total 12.Una <br /> 9a 9b.U.S.DOT Desulpdon(indudm9 Proper Shipping Name) <br /> Na Type QWntay WLM• <br /> 1. <br /> Non-Hazardous Villreste Solid(Soil) 1 `� Y <br /> Lu <br /> 2' Received <br /> 12-08-14 <br /> s. via E-mail <br /> CRA, INC. <br /> Indianapolis, IN _ <br /> 4. <br /> 13.SpNW Handing Instructions and Additional Informadal <br /> RIPR9: 103497 SAP#10008377 <br /> Wear protective equipment while handlfig. Masi is or volumes InadenW. 989 183 Proffiq4212107702 <br /> are approximate. 24 hour emergency number(M)4249300 Project 9: 74028-14; CRA#241359 <br /> Chemtrec. <br /> 14.GENERATOR'S CER MATIONi 1 certify the materials desalted above an thio manifest are not subject to federal br proper disposal of Hazardous Waste. <br /> GeneratoeslOaeroes Prlydedllyped Name SMonth Day hear <br /> AIS on behalf of SOPUS-J Sherman ignatrxe <br /> A 15.International Shipments ❑Import to U.S. ❑Export from U.S. Fort of emrytmat <br /> t Transporter Signature(for aeons onW: Date leaving U.S.: <br /> 1B.Transporter Admowledgernent of Recelpt of Materials <br /> Transporter 1 Printed/lyped Name Signature Month Day Yaw <br /> d 1A�tt t, t/�► � <br /> 1Fansporter 2 Printedayped Name Signaftn Month Day 14ar <br /> Ir <br /> 17.Dbcreparwy <br /> 17a Dborepancy Indxation Space ❑ooantay ❑Typo D ResO, ❑Partial P49ctia, ❑Ftil Rejection <br /> Manifest Reference Number. <br /> 17b,Alternate Fadkiy(or Generator) U.S.EPA ID Number <br /> LL FkWs Phare: <br /> p 17C.SVatue of AarKnate Feraft(or Generator) Maori Day liar <br /> W <br /> Z <br /> L7 <br /> 18.Designated Fadr,y Owner or tion of recelpt of materials covered by the manrast meopt as noted in nem 17a <br /> Print Signature Day 1t~r <br /> 169-BLc-6 5 119 (Rev. ) DESIGNATED FACILITY O GE RA 0R <br />