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NON-HAZARDOUS 1.Generator ID Number 2.Pae 1 of 3.Emer enc Response Phone 4.Waste Tracking Number <br /> ?r <br /> WASTE MANIFEST C A L 0 0 0 4 2 4 8 1 7 �8006p249136 C D F L - LAT - MAR 20 <br /> S. C�141" IIT LINE INC. C� rl1b ' il �l�r ` L� df . <br /> 500 OLD DOMINION WAY 601 DARCY PARKWAY <br /> THOMASVILLE NG 27360 LATHROP CA 95330 <br /> Generator's Phone: 336 8225760 <br /> 6.Zranspgrte 1ompany Name U.S.EPA ID Number <br /> Ya rlo nVVlrgnmental Services C A D 0 5 3 8 6 6 7 9 4 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.13R081i ftffp�Ndress U.S.EPA ID Number <br /> 1630 WEST 17TH STREET <br /> LONG BEACH CA 90813 <br /> Facility's Phone: 800 827-6729 C A D 0 2 8 4 0 9 0 1 9 <br /> 9.Waste Shipping Name and Description } 10.Containers 11.Total 12.Unit <br /> No. Type Quantity wt./Vol._ i BREAD <br /> cc MAKING FAT.STARCH, BEEF BROTH. DRIED SUGAR. <br /> a MAYONNAISE,SALT, FLOUR 00 ) DM 5`0 <br /> W <br /> z v FeODSTHFIF <br /> - <br /> tr ry ;n: �r _ # . (i`i)R C 1D � VRSr`iUi'. aF-:�tr � �- 1<✓ �Q® <br /> —i-;F:.C€tl'I"i liti€3ti'R <br /> �'liii Tri?; ';: P,i -.7;CY r'l'PXV,.R DANCE Wi i':I T1 1E YHOVistONS OF <br /> FF.-,LUSCURC ou;%:S1.....,„'1:,._ Ac. TOGE111. '�Si; i Ar'PLWARR <br /> '€S)'LJLIL- ANI) 11'6:t.Ct: r'F.i;'.!S:t'iit:�: _, Ci.:....,. . ..,._..�?Iv HAS .: L OF HE NFCEk SAl27 <br /> 7'D ACIC!i:'a'':M I:ci�;� :;•3�ii:i::.'� '+z':>.::'� �i,!-iD ii.L-n L: IVASTa 11A3 Ua-'N HAXDLPJ1 <br /> ,••liNlt•,c i ii.1' <br /> 4. <br /> 13,i8ogal f&WJnF'Ii Rd Additr4nalanforrhatioC� <br /> a-a <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION;i hereby declare that the contents of this consignment are fully and accurately described above by the proper hi(ing C me,and are lassified,packaged, <br /> marked and labeledlpiacarded,and are in all respects in proper condition for transport according tplii mational and national governmental regulations. <br /> G rafor's10crqr'� I totlfType N e � Signatu � Month iiDay Year <br /> © lO <br /> J 15. nternational Shipments <br /> z ❑Import to U.S. ❑Export from U.S.U Port of entry/exit: <br /> Transporter Signature for exports only): Date leaving U.S.: <br /> x 16.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Tran orter 1 Printed/Typed Name Signatu Month Day Year <br /> 0 75 t - oN � - t)3 10 <br /> zTransporter 2 Printed/Typed Name Signatu Month Day Year <br /> cc <br /> H <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space 11 Quantity ElType ElResidue ElParlial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F}- 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> u4. Facility's Phone; <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> c� <br /> N <br /> W <br /> D { <br /> t� <br /> 18.D signated Eacfllty Ow0 or Operator:Certifigation of re eipl of materials covered by the manifest except as noted in Item 17a <br /> r Print /typed N e Signature Month ay Ye <br /> 1 "a <br /> c - 2 <br /> 169-BLC-0 5 119 7(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />