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<br /> NON-HAZARDOUS Generator tD Ntr 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number
<br /> WASTE MANIFEST 1. (800)�I%44� 07430�
<br /> '094 sr{er�tp� ame.FIM
<br /> M�glga p �sg Generator's Site Address If different than ma8ing address)
<br /> �it1904�f1Yli"Of1r1' ?tlAat NrMni 3geft-nt G0. f.he�1ft'61f1 ��
<br /> do Chevron Prorum.GernpanyAme Dem f��'333 Nt3Gi�tu AveP,O.Box 6004
<br /> 1:ia1z f<woo�,CA 94583 (1377)stst`.1-•i3(m `itttt�kft�tl,CA
<br /> Generalor's Phone:
<br /> 6.Transportor 1 Company(dame U.S.EPA ID Nutrrber
<br /> BFI-SHIRE CAROGM3913
<br /> 7 Transporter 2 Company Name U S:;EPA ID�Vu(rS[ier
<br /> 1 A, `
<br /> (x�J13
<br /> r ';B❑ 1yn81
<br /> Mer
<br /> and She Address U.S.EPA ID Number .
<br /> �7�c"�uf3 W tL=rend)Aolb tea LLC
<br /> '6871 * Bayle Aven4e C;A00070r.�09193
<br /> Vernon, LA 9W50 (328)277-1600
<br /> Fed Phone:
<br /> 10.ContaY►ers, 11.Total 12.Unit
<br /> 9.Waste Shlpping Name and Description
<br /> N0. ' , 'Type Ouertbly WINo1
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<br /> Nary-DOT Reg0latecl.Matetial.(Netraleitm Ctintaat Water, ��M `/icy
<br /> 11+fn^f1.7;�atYlgG6) 003 .. i
<br /> {y/ a Iv/.0M
<br /> 13.specialHendlln InstrucdonsandAdditionalInformation : CEMC-C,AJ:A*1zFlatAeF
<br /> 1h1 1_L..5I s I DVCON WATER . �3E�t:242 36 l BU$IN UNItr MSU
<br /> ERG-: NIX
<br /> y UF 96
<br /> WEAR LVVgL Q PPE&SPLASH F TRO CIwCTION (IF APPLICAALE) P1;4F1LF_
<br /> 14.GENERATOR'810#00R19 CERTIFICATION:I hereby declare that Gte contents of.thle bonslgrtment are lily and accurately described above bythe proper shipi*g name,and ora classified,packaged,
<br /> marked and labeled/placarded,and are in 611 respecle In proper condition for transport woording to applicable international andpart"governmental regulations.
<br /> Generatoes/Ott roc's PrinteVypd Name Signature t Month Day -Year
<br /> L,3rr'gr Moothart of BES1 €n b6half of 0enorator
<br /> �r I&International Shipments .rr
<br /> t� ❑Import to U.S,. ❑Dport from U.S. Port of enlrylexh:
<br /> Trans rter Signature for exports only): Date leaving U.S.;
<br /> ic 16.Trarlspoder Acknowledgment of Receipt of Materials
<br /> Transporter i Printedryped Name Sl nature . Month Day Year
<br /> per, t.... '1r• i'l ,. Jasn..,. 1. .
<br /> Transporter 2 Pdnted(Typed Name SlgrelGre I y Month Day Year
<br /> 17.Discrepancy
<br /> 178.Discrepancy Indication Specs ❑Quantity ❑Type ❑Residue ❑Peal R*ctlon ❑Fug Rejection
<br /> Mantlest Reference Nunber.
<br /> 17b.Alternate r-acliky(or Generator) U.S.EPA ID Numkr
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<br /> a Faclitys Phone:
<br /> F 17c,Signature of Alternate Facility(or Generator) Madly Day Year'
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<br /> 1&D,ealgnaled Facility Owner or rator:Certification of receipt of matadals c9vered by the maMest except as noted In hem 17a
<br /> PriniedlTyped Name, Signature % Month Day Year
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<br /> 1MBLC-0 6 10498(Rev.9/09) � *� � �� TRANSPORTffR#1
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