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3 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone C Waste Tracking Number <br /> WASTE MANIFEST x,a Argo <br /> c <br /> 5,Generator's Name and Marling Address Generators Site Address(ii different than mailing a dress) <br /> GLIMMT t-4OST3 B,(SWEWA'Y) <br /> 1SON VC-,ST SCHULTE FAD. <br /> TW-Y,CA 95377 <br /> Generators Phone: <br /> 6.Transporter!Company am U.S.EPA ID Number <br /> SH()P*w'ARLw4-'sOLUTKNM,Iw'- <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Vw*m FES ToOhNoW 64*t 3Dns,UC- Kif"0013" <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> VEOUA El TEOMCAL 6OLU`fIOM,LJX <br /> 57M W.JE}�ff'lIt�'MN 2,T. !3[1tu33�7 + <br /> PHOS �(,AZ 00043 <br /> Facility's Phone: 802-733-29 <br /> 9a. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Groan(11 any)) No. Type Quantity Wt A/ol. <br /> o , fund . wAcsT&LAS,t m4-DoT wwxrw-4FT OFT OF <br /> 0 <br /> 2. <br /> AC�{WAS-TE L T F�Er RN T U <br /> T 74 eA <br /> 3. <br /> 4. <br /> 3.Special Handling Instructions and Additional Information <br /> M'.i LK-FOPALL ALL~8#-,MQ7 <br /> 110 <br /> 4. GENERATOR'S CERTIFICATION: I certify the materiae described above on this manifest are not subject to federal regulations for reporting proper • of Hazardous Waste. <br /> Generalor's/0 s Printedayped Name Sgnat '/ r Month Day Year <br /> i �.• f ?i. .�'1' l ��� f 'iJ �... ��•j.;..;,i�:'i L. �,.%4-^ 'rf(r/� �f <br /> J 15.International Shipments. .... r <br /> T•- ❑ImpaA to U.S. ❑Export from U.S. Pott of enhylexit <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> It w 16.Transporter Ac of Receipt of Materials <br /> OTransporter 1 Printed/Typed_Name p. Signature Mo Day Year <br /> Transporter 2 Nnted/Typed Name Signature Month Day Year <br /> F—. <br /> 17.Discrepancy <br /> 17a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Full Rejection <br /> ti 17b.Alternate Facility(or Generator) Manifest Reference Number. <br /> U.S.EPA ID Number <br /> J <br /> U <br /> n¢i Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> C� <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> nnted/Typed Name Signature Month Day Year <br /> 6-NHM-C-C-11 <br />