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NONHAZARDOUS 1.Generalor ID Number 2.Page 1 d 3.Emergency Response Phone 4.101fasteTrad'mg Number q (� <br /> WASTE MANIFEST NOT 17'QI.'R 1 08942:3-tiP980 2.15329 <br /> 5.Gemratots Name and Mailing Addreo; - Genermone Site Adhess(it different than mailing address) <br /> Gx17nx Faililgds 76 GUITx1 l6W6 <br /> 76 arriadww4 Zi ux�msyltW CAOft �7U11�.'Ik�r 31 Tari`3irat*k,)n.CA 952119 <br /> Gonmatoi s Phone <br /> I 6.Transporter i Company Name -' - - U.S.EPA ID Number p y <br /> RxnnrllTrl1#ntcglT9inl15cyd,71>ad.19X'. �lRti0U14tt-338 <br /> ` 7.Transporter 2 Company Name US.EPA ID Number <br /> ?' 9.Dmgnated Fwafty 13Na(ne and Sll, , ess U.S.EPA ID Nimbm <br />• .S4'Naf Yis1 flak 4..9r it <br /> Fadurys Pnme: Pht.Auy{, CA W1,85- - '9A-45B-9500 <br /> 9a. 9b US.DOT Description(includng Proper Shipping Name) 10.Containers l I.Total 12.Unit j <br /> No. Type Dowdy VRAK <br /> 1. <br /> Q NWI-f31e7_PIM(pNi 1100v&M(WO 111 P , <br /> o: <br /> w <br /> to 2. <br /> O <br /> { <br /> 4.1 <br /> 3. <br /> 4. BVI{ <br /> 13.Special Handling Instructions and Additional mOrmagal <br /> t fp <br /> �Afti"x' AG31K5-F9yiFkjl:#1°u'i�5tAs7��N'..RR�tSi{y`. �f7(�1(C[#'Z+•c7d)ltY�flSC1. 9. <br /> rlppraa<IRow ?AMir lATlrsgiat yrturn ek-(me)4zi-Sio" s PtJr , 42121010282 <br /> 1 PcD(WA IT: 71r$hi-9-7 <br /> I <br /> I I, <br /> 14.GENERATORS CERTIFICATION:I ceri the materials desubed above on this meniiesl are not subject to federal regulations an reporting paper deposal of Hazardous Waste, <br /> GeneIp n 1 rryl� f�F <br /> rala4aX�atP+l+tlaamselL'FtYtYa.1:"k�#6VTYi1#S. SigmWre Mond, Day Year <br /> 15.mematbnal Shipmenls ❑Importlo US. ❑ <br /> Erymt from U.S.. 4� Port of emry/e4: <br /> F - - <br /> Transporter Signature gor experts only): Date leaving U.S.: <br /> W 16.Tmnspmer AcluwMedgement of Receipl M Materials <br /> Transporter 1 PdnNNyyped Name - - Signature' - Month 'Oay Year <br /> O <br /> H '! 1 It I1 <br /> a Transporter 2 Pnaedr yped Name Signature - - - `- Month Day Year <br /> Vcr- <br /> 17.Decrepancp - <br /> 178 Discrepancy Indkation Space <br /> ❑OuaMity ❑Type. _ ❑Residlte '❑Pad'¢I Reiedan ❑Full Refection fk <br /> Manliest Reference NUMcer: - 1 <br /> M.Alternate Facility(or Generator) US.EPA ID Number ri <br /> I <br /> 6 <br /> Fadilys Phme: <br /> p17c.6gname of m,r ally I.Dammter) .. Mom oey won <br /> w <br /> z <br /> u _ <br /> 0 <br /> 'I 16.Designated FadW Oewer or Operator:Ceditication of receipt of mate_ red by me combat except as noted In Item 17a <br /> Prmtedlryped Name Signature Marsh Day Year <br /> rI �y � A v nrl ( <br /> 169-51-C-05 119T1(Rev.'9109) ' `. t - ,J: --G tNERATOR'S/SHIPPER'S INITIAL COPY <br />