Laserfiche WebLink
rn <br /> C0 <br /> co N <br /> L _ <br /> L1� O <br /> O O <br /> rr 3333 S Hwy 99 W Frontage HD <br /> n T. O <br /> glockton.CA 95215 C; (918) <br /> fhumgerdner®PApe Com F (2091323130_ <br /> Q I 1 .nuw w108 Com <br /> O <br /> U ,, 1 Gerwralp ID rip„ <br /> � rnr .1 CA L 0 i .. <br /> l Ihlalllddm.1 <br /> d 7RLi 'K CENTFR <br /> IN CA 1 .1 W4AY fly � <br /> 7OD 628 IJW .i,I CA 196216 <br /> i-Rf WLNVIRC)NMENI us,EPA 1DNwanr <br /> aneponn ,,,,nanny Nnnre — u_ C A R 0 0 0 1 1 1 0 1 7 <br /> U.5 EPA ID Nwnbr <br /> e DgalOnplralEClNy_Nappp In ILL.INC- I JA,EPA 1D Number <br /> 3676 1'0 1 HC NO HIL L S.UNE <br /> SUISUN GA H4A86 <br /> Face'.Phone 101 4.3;P-462/ <br /> 9 Waste Sbipping Name and Description 1b.ComomeN It.Tonyt2 Unit <br /> No. Type 0-10Y "I'M Nd. a!w <br /> o I.NON-NA7ARDpuSWAStE.LfUUlu/wASTLWAIERI „r <br /> _ A <br /> m <br /> u d <br /> 3. M <br /> .I <br /> 4. <br /> 73.SdecialHandkn¢Ipsttuy�lOns „Atlditlooal 6"ofBK tie <br /> / <br /> 14.GENERATOR'S/OFFEROR'S CERTIFICATION: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 and labeled+placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generators%ONeror's Printed/Typed Name Signature Monty Day Year <br /> J 15.frimmalional Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> 2 <br /> Trans net Si nature for ex orts—k" Data leaving U.S.: <br /> ¢ 16.Transporter Acknowledgment of Receipt of Materials <br /> cc Transporter 7 PrintedrTyped Name Signature Month Day Year _ <br /> 0 <br /> a <br /> N Z Transporter 2 PrinleNTypetl Name Signature Month Day Year <br /> a <br /> 17.Discrepancy <br /> (1) 17a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> (z <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> r 17b.Alternate Facility(or Generator) <br /> Z r <br /> J <br /> U <br /> w Facility's Phone: Month Day Year <br /> Z3 "I I7c.Signature of Alternate Facility(or Generator) <br /> O a <br /> LO z <br /> O (z C7 <br /> N N w <br /> 0 Czo <br /> Q <br /> U O 18.Designaled Facilily owner or Operator:Cenification of receipt of materials covered by the manifest except as noted in Item 17a Month Day Year <br /> � PriNed/iyped Name Signature <br /> O O <br /> GENERATOR'SISHIPPER'S INITIAL COPY <br /> p N 169-BLC-0 5 11977(Rev.9/09) <br /> U <br /> rn cz - W <br /> L 2! - Print DrlverS hatlit = <br /> Z) T lnn _ . e w <br /> = rn _O —m enx+rl rrv•rn ncc-rimwrinN STATE(IF REQUIRED) <br /> c � <br /> C/) O 0 Q <br /> � Cz <br /> cy) NO U <br /> N = <br /> � � rn � <br />