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NON HAZARDO "`-1-Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST C A L 0 0,,,',,'0 4 '2 4 8 1 7• 1 18046249136 D D F L - L A T - J A N 1 9 <br /> S.Generators Name and Mailing Address At LAUREN AKINSr.eneratoes Site Address Cf dffereni than mailing address) <br /> OLD DOMINION FREIGHT LINE INC. OLD DOMINION FREIGHT LINE INC. <br /> 500 OLD DOMINION WAY 601 DARCY PARKWAY <br /> THOMASVILLE IVC 27360 LATHROP CA 95330 <br /> Generator's Phone: 3368226760 <br /> 6.Transporter 1 Company Name U.S:FPA 10 Number <br /> Patriot Environmental Services C A D 0 5. 3 8 6 6 7 9 4 <br /> 7,Transporter 2 Company Name U.S.EPA 10 Number <br /> B.Des�ROSBY&OVESite <br /> f N U.S.EPA 10 Number <br /> 1630 WEST 17TH STREET <br /> LONG BEACH CA 90843 <br /> Facir 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 WtNol. <br /> i. FOOD STUFF-JALAPENOSIPRODUCTSJ SEA SALTMUTRIENT <br /> o DRINKSMTAMIN CBIRD FOOD/COCONUT FnICORN l <br /> a MEAL ° �U } <br /> o P <br /> z <br /> W 2. <br /> 'nM REFERENCED WASTT WAS RECEN I D.HAMU D AND STORE POR Str Egw4P'f' Ff'S[i�:. '.:.:.. <br /> OfSPOSAL.TREITMEttr C R REusE CRD BY A GVE tTON.INC UP TES <br /> 1'Amus CRAKVED TO M I LPA.BY TI GE DE ZIARTM.14T OF TOXIC sod FANCE 6 <br /> 4. TIIR RESOURCE CONSERVATION AND RECOW.RY CT OF t976'T GEnux <br /> FEDERAL APED f f IE LATIONS, OSBY 2ti) <br /> OVERTON FIA At4;:D-':Tli.j.[rECF5SAR1 <br /> PER1d1TS To ACCF3T RF1'F3tEN WASTE ALL TFC I IASM 4 S:Bk'EH;NANULxT. . <br /> �-19-00064. (PETROCxEM PO H35217-19) <br /> &A. <br /> �0�17 <br /> (A-3c( 90 CA9fl2-K $r `'j'D 1062 9 o <br /> CV910 LA <br /> 14.GENERATOR'SFOFFEROR'S CERTIFICATION:f hereby declare that the contents of this consignment are fupy and accurately described above by the proper shlppingname,and are classlred,packaged, <br /> marked and labefedrplacarded,and are In all respects in proper condition for transport accord ng to applicable Intemational and national governmental regulations. <br /> Generalor' [forces PrintedlTyped Name Signature Month day Year <br /> 10) 12-411 <br /> ..r 15.Intematfonal ShipmentsIm rt 1°U.S. ❑ <br /> po Export from S art entryleAt: <br /> z Trans ature <br /> Transporter 5t nfare ds only): a leavfn U.S.: <br /> cc 16.Transporter AcknoMedgment of Receipt of Materials <br /> Lu <br /> Tran der�nwcl)Typod Name Signature Month �y Year <br /> 0 loll 17 <br /> CL <br /> .In M soofw <br /> a Transporter 2 dnWffyped Name Signature Month Day Year <br /> cc <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑ouanlity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mangost Reference Number. <br /> 17b.Attemale Facigty(or Generator) U.S.EPA ID Number <br /> a <br /> ci <br /> u< Facility's Phone: <br /> F17c.Signature of Alternate Facility(or Generator) Month flay Year <br /> 2 <br /> W <br /> O - <br /> 18.Designated Facility Owner or Ope tor.Certification of receipt of materials covered by the man lest except as noted in Item 1 <br /> Prinied/fyped Name Signatu MonthDay Year <br /> 169-F3LC-D 77[Fiev.9108] DESIGNATED FACILITY TO GENERATOR <br />