Laserfiche WebLink
NON-HAZARDOUS 1.Generator ID Number 2.Paged of 3.Emergency Response Phone 4.Waste Tracking Number <br /> t < STE MANIFEST y f t 4, I .PCF,^ r71C} iy_}rt4N t, !t ii i ; (! ;j'T' t"p,Lr <br /> 5 G !a)ofSN e a d Mailing Address ;iSC vl�i��I1�..L:�{L Generatofs She Address(1f different than cashing address) <br /> i,,iltLCr,Ek{T. 10-.',f 4(' v 51Oh1L`C71"'.. HERS <br /> td;' <br /> 5'6PACIFIC 5it111 L K iO 60110 Pr#OFIC A F'NL)L <br /> ' SITOCKrON k` y, s* TOGI TChI CP £15.67 <br /> Genmalofs Phone 2,G9 47 Rrl }1 <br /> 6,Transporter 1 Company Name U.S.EPA ID Number ? <br /> {,N"L;, '-=N ikct0f`lM@'l'T J_Ff1'al'iV110ES HIC.. " ^ fS fj <br /> ' 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ,f <br /> 8.Designated Facility Name and She Address U.S.EPA ID Number r <br /> ' P4"P'REF-110 i-RUJi LANDFILL <br /> SLtISLtr,) r--M' CA € H <br /> Facilil esPhone: 'yri7 , 1;,. , <br /> ' 9.Waste Shipping Name and Description 10.Containers 11,Total 12.Unit <br /> No. Type Ouanfdy WWol. <br /> 1 '1T r <br /> Fk,.W ; id ,c l.st; <br /> W 2. 3 <br /> 1 3. <br /> Pri <br /> ' 13 Special Handling Instructions and Additional Information <br /> t1^ZT2 .IaE'cl?..:iR.'sATL; 'r.-t,F�E,GZ•Lnt; BCtG,�'e'x;!:rfT1lF: <br /> ' t$.Cr's.awf'S-t.'f.J1✓`'isV'1Tgi.Pr.rCY4 CQ1'19ULP'.%rF',?x IlfG- 21CO <br /> .•T,aOuL;Mh{1.'`ZIJtiL'tYF,,'AV <br /> 9:15"42 <br /> 1 ; 'P„t <br /> JyF•'.fy@zSep r( itIi'$ Pff.4 C:1ft11':itih., <br /> qol� <br /> 14.GENERATOR'S/OFFEROR'S CERTIRCATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked end labeled/placarded,and are in all respects in proper condition for transport according to applicable intematfonal and national gammmenlal regulations. <br /> ' Generatots/OHeror's Primecirfyped Name Signature ..., ,,o— .- Month Clay Year <br /> tri 15,International Shipments ❑Import to U.S. ❑Exp try Export U.S. .Port of en /exiC <br /> z <br /> Transporter Signature for exports only): —Date leaving U.S.: <br /> m 16.Transpoder Acknowledgment of Receipt of Materials <br /> ¢ Transporter 1 PdntedrTyped Name--y '� Signatryra` .� r"'- j 'J Month Day Year <br /> au <br /> z Transporter 2 Printedhyped Name 'Signature` t Month Day Year <br /> H <br /> ' 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection El Full Refection <br /> Manifest Reference Number. <br /> ' 17b.Alkmate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> ua. Facility's Phone: <br /> ad 17c.Signature of Alternate Fadliy(or Generator) Month Day Year <br /> a <br /> z <br /> N <br /> W <br /> 1 18.Designated Facility Owner or Operator,Certification of receipt of materials covered by the manifest except as noted in I)ero 17a <br /> PnntedrTyped Name, _ SignaNre / ^""'~ �I t th ,Day ?Year <br /> 169-8LC-O 6 10498(Rev.9109) j T RANISPORI�R 1.'2 <br /> i <br />