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NONHAZARDOUS 1.Generator ID Number 2.Page 9 of P. <br /> Emergency Response-Phone 4.Waste Tracking Number '• a <br /> WASTE MANIFEST I fdd ' t" ?;'t x"'" +''4 g . . ; :. '•,. <br /> 5.Generators Name and Mailing Address +Generatofs Site Address <br /> �(If different than mailing address) ' <br /> ti l 1 � '�-!'Td+�.�k. ,'') <br /> enerato s Phone: <br /> 6.Transporter 1 C mpany Name U.S.EPA ID Number <br /> 7•Transporter 2 Company llama ' U.S.EPA ID Number. <br /> 8.Designated Facility Name and Site Addressf U.S,EPA ID Number <br /> les "rt���'pnl^r. <br /> aaclli 's Phone, <br /> •10;Containers 11.Total; 12,Unit . <br /> 9.Waste Shipping Name and DescriptionNo. Type" Quantity WCNoL . <br /> 4v A 51 <br /> oc <br /> W •:..... <br /> ry <br /> � � <br /> 19,,5 eciai Handling Instructions and Add tional,Nfo[m ;.,N� �.`';�t°,"A'.', �,�ir � ;�;�.�'. �•„ �+;,, <br /> 16 <br /> 5 <br /> 14,'GENERATORIS/OFFEROR'S CERTIFICATION:I hereby declare that the:contents of,this consignment are fully.and a`cgurately descHboo above by the proper shipping name,and are classified,packaged; <br /> marked.and Jabeled/placardgd,and are in all respects in proper condition for transport'according to applicable ntemational'and�ational g8v'mmental reg4lat(ons: <br /> Signature Month Day Year ' <br /> Gerperatoi's/ fferors Printed(Typed Name 9-- � , ) <br /> ji 15,International Shipments O'jmport to U'S. D Export from U.S. Port ofentry/ex(t. <br /> Trans orter SI nature for ez orts onl Date leavin',U.S•:. <br /> o: 16,Transporter Acknowledgment of Receipt ofy1 t rials. 4 <br /> ^M• SI nre th D y Year <br /> Transporter 1 Printed/Typed Name - gatu """�R, <br /> ! w r ;• + '"Month' Da Year <br /> a .Transporter 2 Pdhted/Typed Name. . y <br /> 17.Discrepancy <br /> 17a:Discrepancylndicailon Space ,, Quantity ❑Type 1 Residue Parti.1 Rejection ❑Fuli Rejection <br /> M6IfesVReference Number:: <br /> 17b.Altemate Facility(or Generator) U.S.EPA dD Number; <br /> U <br /> ILE .Facility's Phone: <br /> Lu 17c,Signature of;Altemate Facility(or Generator) Month Day "Year <br /> a <br /> v <br /> 18.Designated*Facility Owner or .0perator•Certiffcat(on of receipfo(matedals covered by'ihe manifest except as(noteif In Item 17a <br /> PrintediT petl m9 ! y Signature `" Moppth , Day Yea <br /> �j� trd <br /> TRANSPORTER#2 <br /> 169-6LC-0 6 10 r (Rev.9/09) ' <br />