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NON-M¢ZA REE)OUS I I.Generator ID Number2 Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFESTI ODE I Al - MAY <br /> 5.Generata's Name and"Andress Alt:LAUREN AKINS Generators Site Address(4 Wereni than mailing address) <br /> COLD DOMINION FREIGHT LINE INC. OLD DOMINION FREIGHT LINE INC. <br /> 600 OLD DOMINION WAY 601 DARCY PARKWAY I <br /> THOMASVILLE NC 27360 LATHROP CA 95330 r, <br /> Generators Phone: <br /> B.Transpoder 1 Company mo U.S.EPA 1D Number <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number I' <br /> S.Desoaled Fadliy Name and Site Address U.S.EPA ED Number <br /> CROSBY&OVERTON <br /> 1630 WEST 17TH STREET <br /> LONG BEACH CA 90813 <br /> Fac4 s Phone: <br /> 9,Waste Shipping Name and DescripWn 10.Canianers 11.Total 12.Ural <br /> No. Type Cuantity MtlVol, <br /> Ir <br /> 1. <br /> i <br /> 2 <br /> NON HAZARDOUS WASTE LIQUID-FOOD STUFF <br /> 002- DF 12-00 <br /> t <br /> 3 <br /> 9, <br /> I' <br /> 13.Special Handing Instructions and Ajtional dnformation <br /> USE PROPER PPB JOB # 08-19-00194 (PETROCHEM PO H35780-1.9) '"^�°'� 2) 108739 <br /> CA4302, CA4306, CA4307,CA4312, CA4313, CA4347, CA4378, CA4383, CA4384 (2— qE�, 1 <br /> t .�f"J r <br /> 14.GFNERATOR'SMFFEROR'S CERTIFICATION:I hnr W dedare that the mrttents of this r. Wgriment are ItaEy and accurately descdx�d above by the proper sh)ping name.and are classified,packaged, <br /> marked and W*ledlptacarded,and are in all respects in proper optlOw ter transport atxDr ft to a x:able international and national governmental regulations. <br /> Ge ratorswerors 'te&7 Name I Month Day Year o-1 17 <br /> ..3 1 .InlematbW Shipments <br /> ❑Irnpori Io U.S. ❑Export tram .S. Pod of entryfexit: <br /> jgjTLrlerSIqmIum lore Date 10LAA U.S.: <br /> w 16.Transporler AcknoWedgmeni of Receipt of Materials <br /> GTru er i PrinledrTyped Name t Signa Day Ye r <br /> ill. <br /> S H <br /> z Transporter 2 FMIeVyW Name Signature MotAh Day Year <br /> 17.Discrepancy £ <br /> 17a.Discrepancy Indiratiaa Spate ❑ouanwy ❑Type ❑Reso. ❑Penial Rejection ❑Ful Rejectaa <br /> 1 <br /> ftffesl Reference Number. <br /> 17b.Aflemale Fae7ty(or Generator) U.S.EPA ID Number <br /> .,a <br /> ua. FaciWs Phnno: { <br /> w 17c.Signature of Agemate Faciluy(or Generator) Morah Day Year <br /> a <br /> x <br /> cs <br /> to <br /> w <br /> 16.Designated Faci ty Omer or Operaliar Cenircation of receipt of materials covered by the manilesi except as noted in Item 17a ' <br /> Ph"edrfyped Name Signature Mwh Day Year <br /> i` <br /> 169-BLC-0 5 11977(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />