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*qo,s 2F �;02--7 <br /> NON-HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST I N a T REQUIRED i 808-42343= 4OQ4D-46-028 <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> 7-Ewftn 7-E*VM SWO N0, <br /> P.O.Bax 711.Da fta TX 7'5221 AIM On VW Dr.,Sbckbn,CA 9=7 <br /> Generators Phone: !72) <br /> 6.Transporter 1 C m an"y � U.S-EPA ID Number <br /> 1 NOT REQUIRED <br /> T.Transporter 2 Ca parry Narrd U.S.EPA 10 Number <br /> a.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Vftob GAfWWC& -Pairare Hft La nM <br /> 3M Potrero Hlfls Lar>te,Sub=,CA 94585 NOT REQUIRED <br /> Facif• 's Phone: M5)9491 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total i2.Unit <br /> No. Type C iantity wt.Nol, <br /> 1. <br /> a <br /> a <br /> Wo fi2111*0011 rs Ylif1sll,Sold(Soil) 001 D T 10 Y <br /> Lua <br /> a 2. <br /> w <br /> [7 <br /> 3. <br /> 4. <br /> 13,Special Handling Instructions and Additional Information <br /> $off:99-1w% PFCft W. F iLF21D-M7 <br /> Debris:0-1x <br /> Wow f-pprop-is PPE when heroMM of n req dyed Icy Ve TSDF Project No:40280 <br /> 14,G ENE RATO RVOFFERO R'S CERTIFICATION:I hereby declare that the Contents of this oonsignment are fully and accurately described above by elle proper shipping name,and are classified,paekaged. <br /> marked and labeledlplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> GeneraaorslOfferors Printedrryped Name Signature Mon Da Year <br /> Poof CSC WZorYl"on li~0(CAwa1'abf P6Z%CkX6oC*7neM CA4p=4 Fall+) <br /> ri 15.lntemational Shipments 1711-port to U.S. ❑Export from U.S. Port of entrylexit: <br /> z Transporter Signature(for expons.only): Date leaving U.S.: <br /> cc t6.Transporter R knowledgment of Receipt f Materials <br /> w <br /> Tran ePn c�Typed Name Signature Mo-n Day Year <br /> ¢ J(nJ <br /> a <br /> 0 <br /> E Transporter 2 Pdntedlryped Na, a re Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity L1 Type Ll Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> CI <br /> I Facluty's Phone: <br /> 17c.Signature❑f Altemate FacRy(or Generator) Month Day Year <br /> a <br /> z <br /> c� <br /> Vl <br /> uJ <br /> O <br /> 18.Designated Facility Owner or Operator:CerMication f receipt of rnaaeriats covered by the manifest except as noted A17a <br /> Printed/Typed Name Signalure Month Qu Ye <br /> 169-BLC-0 5 11977(Rev.9149) DESIGNATED FACILITY O GENERATOR <br />