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NONHAZARDOUS 1.Generator ID Number 2.Page 1 ofEmergency Response Phone 4.Waste Tracking Nwnber 0702877 <br /> 8 <br /> WASTE MANIFEST NOT REQUIRED 3, <br /> 888.423-6060 <br /> Generators Site Address QI different than mailing address) <br /> 5.Generator'sName andMatingA'd re,.,ss.:N. 76 ion#58M <br /> (,01'IproPhl�llp6 <br /> 76 13IM011VAay.Saclarnetlto.CA 95818 2701 W.Mach Lane.Stockton.CA 85218 <br /> Generstoes Phone: <br /> B.Transporter 1 Company Name U.S.EPA ID Number <br /> Arnericart InteglIged Services.Irm CAROW148M <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 9. nate Fadll�r me a d Slte AddG U,S.EPA ID Number <br /> 1630 W.16th 8415d1ll �,�,., CAD028409019 <br /> FadWs Phone: LdV Baha�x0813 �-M-644{ <br /> 10.Containers 11.Total 12 Unit <br /> 9.Waste Slipping Name and Description No Type Duamity W Wol. <br /> 'w 1. TT <br /> o Yi s Non-Howdous Wasteuid <br /> u4 , 15 o G <br /> W u <br /> Lu 2 <br /> M <br /> 3. <br /> aj I= <br /> s; 4. <br /> M.Special Handing Instruction and Additional Wormatkn <br /> Wear protective equipment whits handling. Weights or volumes are 0 In f2�t <br /> applmdmata 24 hour emergency number(SM)42344(AIS <br /> pip ProAet 27578 <br /> Pffliad#: 710MO-7 3 t�r�rYl <br /> 14.GENERATOR'WOF'FEROfl S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,padwgied, <br /> marked and kbeledoacarded,and are In an respects in proper condition for transport according to applicable kdema• I and n tional govem3praal regulations. <br /> Gener� _j,&E YM Signalu Month Day Year <br /> 1 I <br /> IS.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. ort of en <br /> Transporter S: tore for exports on Date k .S.: <br /> cc 16.Transporter AclawwledgmentofReceipt ofMaterials <br /> rc Transporter 1 Plnted?yped Name Signature Monty Day Year <br /> N r�\Q Cl t I lI <br /> a Transpohdr2 PdntedRyped Name Signature Month Day Year <br /> x <br /> r <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantiry ❑Type ❑Residue ❑Partial Rejection ❑Fun Rejection <br /> TIE REFERENCED WASTE WAS RECEIVED AND TREATED TO STANDARDS MANDATED BY THE FFDERAI <br /> CLEtN WATER ACT AAD FJ•F1.L'E�?.REQL'IRk�fE1TS SET FORTH BY 711F LOS'4XIIIII1 WaloeNWumber <br /> c <br /> 17b.Alternate F%1IypU:Gerletelon)BY T1BE DEPARTafENT'OF TOXIC SIBS'TANCE CU\TROL TOGELWANIEDT CRRSBYA U.S.EPA ID Number <br /> FN`/IRON\tE�'TAL PROTECTION AGENCY W ACCORDANCE u III T11F PROVfS103S OF T11E RESOIIRC'F <br /> r`UNSErRVATION ANDRECOVERY ACT OF 1976 TOGE110t Wail APPI.ICABLE FEDERAL AND STATE <br /> Q REGULITIONS CROSBY <br /> Facility's Phone;E d OVERTON HAS ALL OF TIC, NECF,SSARY <br /> LL PELNiI'S 7`O.ACCFPT,•TNF <br /> ILIXA AN <br /> F 170.Signature UP, kQMQk*t pWT3Sr W&)T1�Ct]tTo-ICATE HOIt�FR•S UABILTTY HAd gfF!!'1'W,rW,I JK T Month Day Year <br /> z <br /> z <br /> (Ai";•i'rw�3r.(.y+<�.'S :l}'';; a <br /> „r s <br /> 18.Designated.Factiity Owner or Operator.Certification of receipt of matelots covered by the manifest except as noted in Item fire <br /> PdmedRyped N Signatu Mom11 Year <br /> Ako <br /> 169-13LGO 5 11977R.ev*9109). DESIGNATED FACILITY TO GENE TOR <br />