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NON-HAZARDOUS 1.Generator ID Number 2.Pa91 of 3.&nergency Response Phone cWny Number <br /> WASTE MANIFEST NbT.APPLICABL-v . . . - . - 9.Waste Tra0-953-83 '. <br /> 5.Generarofs Naine and MIN Address F - - Generator's Site r'd&=(R Merced than maifug address). r <br /> Generator's Phone: ,. .6t <br /> 6:Transports 1 any Name UA EPA ID Number <br /> -QST A .MMLE <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desk,Inated Fad* <br /> NName�rand Site tAdddrres;sT s 1 i US.EPA ID Nurribst/�. I C <br /> WS BAYPOP,-!)i.f"i,iY FILL- NOTA <br /> 3,L4ABLE <br /> 6-IM HAY TOAD-VACAWLLE?CA 135s�7 <br /> Fatal'es Phone: ( 67&47 <br /> 9.Wasta Shipping Naand Desmiption 10.Co rays 11.,Totat 12 Unit <br /> Na Type., h Wt Yol <br /> QA. <br /> UJ <br /> 2 � <br /> O f „� = <br /> -y <br /> 3. :� � <br /> 4. F �7 <br /> A-7 <br /> T3.'Special Handfng Instructions and Addrtionral Information <br /> 4.GENERATOR'S CERTIFICATION:I der6ly the materials desuiWd above on this manliest are not subject to f edew regtdat ons for"-ng proper disposal of Hazardous Waste. <br /> Gen4prator'iweroesPrinted?ypedName Sigrtahaa T !f� Month Day .`:-Year <br /> �} 1 Irl <br /> 15.Intemasonai Shfpmemsr i ' <br /> impcd to`U.S. ❑1 xpartfrom UA/I Pod of entrylat <br /> Trans rtes S'nature for rrs only): Date leavin U.S.: <br /> im f 6.Transporter Acknowledgment of Receipt of Materials <br /> ur <br /> T r 1 Prmtedliyped Namer Sigredrre Morrth: Day Year <br /> CLL. <br /> Z <br /> Transporter 2 Prtnted(Typed Name Signahao / Mares' Day Year. <br /> 17.Discrepancy . <br /> 17a Discrepancy Indication Space ❑ a+ Y 0 Type El Residue' ❑Pertial Rejection Full Rejection <br /> Manifest Reference Number. <br /> 17b.A temate FaaTdy(or Generator) U.S.EPA ID Numim <br /> FaaWS Phone: <br /> LOU 170.S'gnature of Altemate Faarly(or Generator) Morith Day. Year <br /> W ,� •�ear-- k+^ 3.r^ n?t Te,.{-���� --r -� - ��`� -..: r..c._"'����� �"..,y- n +.a e ��' ..f' �r-. <br /> Sn <br /> 18.Dsslgrwted""7•Faclk,6ner or Operator Cerfrficatim of receipt of materiels aver by the manifest Ec.ept as noted in Item 176 r <br /> PrintedlfypedName Sklnatrae f,' Month Day Year <br /> 16"LS=C 5 119 (Rev.6/06) TRANSPORTER#1 <br />