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0 0 Q <br /> Q <br /> CD <br /> W NaH•HA2ARfl0U5 I•Generaldr Q Number 2-Page 1 of 3.Emergency Resp-Phone 4.Wam Tracking Humber N <br /> 7 ¢ WASTE MANIFEST Cr �' 00 <br /> r <br /> n � 5.Generators Name and litailing Address Generaloes Site Address CA differenl gm mailing address) Np fll <br /> M $n <br /> I-•; N <br /> � a Generators Mom:: i ��'i <br /> O <br /> r. B.Transposer 1 Comp"Name U.S.EPR ID Number <br /> C t.TrwWorler 2 Company Name U-S,FPA 1D Number 1n <br /> � 3 <br /> CD 6,Designated Fed"Name aN Site Address U-S-EPA ID Humber (.Q <br /> CDCD O <br /> . l I rr —7 Cn <br /> FeCiwS Phpta' <br /> 10.Containers 11.Total f2-um9.Waste Sh-q+piog Name and O�onplbn No. T �nryry wuVoi. <br /> � YPB � <br /> O td <br /> � 3- <br /> iy <br /> O <br /> 4- <br /> 13 SPeOial Harldfmg Instntctions and Adddiw al lnlOrotatiorl <br /> L <br /> 14.GENERATORIYOFFEROR'S CER71FfCATION:I hereby declare Bret M contents of this consignment are 1e1By and aacuralefy describedoboe by the propar altipping Hama.end aka classifiad,packaged. <br /> marked and Ia6eledlPtacarded,acrd are In all mV"in properoonditlOn for[renspos accarWng to applicahla inwmabonel end rmdoral <br /> Generalor'srOHemes Pnnfedrfyped Name Signature Month Day Yaar <br /> 15.Intemat"i Shipments ❑ . 11&,n irom U.S. Port of ermomt <br /> Tran rter tura Ore n hrtpwi b U.SDel, <br /> cc 16.Traftorler Ackndw64nerY of RK*of Matadors <br /> OTratlspd�r er 1,P�Irdadrlyp,d Name `f Signature AWnfi Day Year <br /> Q TransPdrter 2 PrirgWyped Name Sviatlre Month DaY Year <br /> F <br /> 17-Ddcmpaal y <br /> 17a fliserepancy lr>diwW Spam Elan" ❑Type <br /> ❑Residue ❑Partial Rcgepidn ❑FW ReyftvOn <br /> Maneest Retararl[n Number; <br /> 176,Allemate Fap7rty for GerierabrJ U.S.EPA 1D Number <br /> V <br /> ram- FaG11t�e Phos,: <br /> Q17c.Signature of MQernare Fadlity(or Ganerow) Day Yom: <br /> z O n <br /> m O <br /> 18.Designated FactNry Owner or Operalor.Cervficzbon or receo d maWats Q vwfod by ate mamrast except as now In llem 17a <br /> PnnreVyW Name Slgnalura <br /> Mp11h Day YOsr 0 <br /> 169ZLC•0 5 11977(Rev.SM) GEN ERATOR'SISHIPPER'S INITIAL COPY <br /> CDO 00 <br /> O <br /> N <br />