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NON-HAZARDOUS 1.General ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST 4 7 <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> :STOCKTIN UNIFIED SCH 101- DIST. <br /> 1932 N. EL PINAL DR. <br /> TOCKTrON, GA 95205 <br /> Generator's Phone: - 7 1 A <br /> - <br /> 6.Transporter 1 Company ame - - U.S.EPA ID Number <br /> AERC.Goin Inc.. CA_D2 E24119•? <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Addre U.S.EPA ID Number <br /> ERC.r*ewri,Inc.. _ <br /> -33677 <br /> ai .Jc i4 a <br /> Facili 's Phone: 51L-4'29-112'9 ; <br /> 9.Waste Shipping Name and Descripti n 10.Containers 11.Total 12.Unit s <br /> No. Type Quantity WtN01. <br /> lanicio for ri ovoling-n_, <br /> Q e D ut-N6f-1-RegUIa!e.1 t- <br /> W i art <br /> 2. <br /> used'rent non-ocb's(b illaqWor rely-sling-nC 'pasta _ <br /> A' 3, <br /> ' " ed'spent baltFrles,drb rr,ntBEn#n potassium hvdr,oxlle <br /> +e 'c0lfia_:,Un•=1i2=,F'Glit(Ert -#I54'1univer52l 'rvaste <br /> 4. <br /> used%spent batlerle:_ yv' filled 94h. <br /> aC1d,P�,U! ?9�:Pr3ill(EF rj <br /> 154)unl'yarsal vrq*aste <br /> X13. Special Handling Instructions and AdditionE I Information <br /> "F".r r- 15 <br /> 14.GENERATOR'S CERTIFICATION:.I certify a materials described above on this manifest are not subject to feder gulations for reporting proper disposal of Hazardous Waste. <br /> Generators/Offerors Printedrryped Name Signat Month Day Year <br /> L 46--� � <br /> 15.International Shipments ❑Import o U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter Signature for exports only): Date leaving U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of terials <br /> Transporter 1 Pdntecl! Name Signature Month Day Year <br /> CL 19 <br /> U) <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quai lily El Type 1:1 Residue 1:1 Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> r 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Uta <br /> LL Facility's Phone: <br /> 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> D <br /> 18.Designated Facility Owner or Operator.Certific ition of receipt of materials covered by the manifest except as noted in Item 17a <br /> Printe ed ame nature th Day Year <br /> 29 c <br /> 169-BLG0 6 10498(Rev.8106) DESIGNATED FACILITY TO GENERATOR <br />