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<br />WASTE F.JANIFEST 1
<br />1. Generator 0 Niltilber 12. Page 1 oT1 1 ?O" .APPLICAME I / 1
<br />3. Emorpney Response Phone
<br />07,,, 7),x6..?- 7770 .
<br />I 4. Waste Tracking Number i 0 •
<br />9
<br /> '7
<br />l u.N.; g —
<br />5. Generators Namo end Mailing Address Generators Site Address (if tirtferent than mailing addres....) •
<br />j42yher,,/6- /‘‘!)/e7t.Jej-LI.E.S. 779-, t..2_'"fr.". f glir- /Jig hel.:9•4=i0/ .91,. /;," /.4.$ .•`4....5 045157- •
<br />309/ ..5-, c.;,.,?42.0 g.4,57- , ,‘.47:-..-.4•FaA "Fe,,01, rst.e..e1=',AS,-5- </e.,te i e:2 ,45.,73.,."7-5 — , •..5,51:0 C./Z-42,`-`Fk' y 5; fX./ Te,e,r-n,:c °fp) C.-, - 7
<br />Generates Phone: ,,76,5? - 7tvg- .9.e.2,5 - p -.. 2 ,A-.).-.5<rzil,A,-A.:7),f..) 3 4--...-..3: ..
<br />5. Transporter 1 Company Name U.S. EPA ID Number _,..„ .
<br />,.% \""•,4,-____4.,_.7-7.4.,!,-,/..4-.1.c.s1V-'07,0-,•(.1.77-••'-‘ 4 i "We- i NOT APPUCABLE
<br />7, Transporter 2 Company Name ....D. U.S. EPA ID Number
<br />i NOT ikcPLICAeLE
<br />
<br />B. Iligneted Factity Name and Site Address U,S. EPA ID Number
<br />
<br />ECOLOGY H.V1 -SCAT; P407- APPLfrAet.E.. -
<br />6426 1-1AY ROAD - kfft=ftt-LF„ CA Sfie87 .
<br />Fadlities Phone: (707) 678.4712 I I
<br />1 9. Waste ShIppIng Name and De:sorption 10. Containem i 1. Total 12. Unit
<br />---- 1 No. . Type Ocanttly WiNol.
<br />..
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<br />1- 1.1.0,Ai ^ iii4Z,4c4 60..5
<br />I- 5e) /z. C ,-.) l 0 , Vr e-). g y , — :
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<br />13 Special Handling Inductions and AdditCnal Informetion / %.504,... e9 .2..s.-*
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<br />14. GENERATOR'S/CFFEROITS CERTIFICATION:1 tweby Seders drat the =tants et this consignnetrefe Piety and accurately described above by the proper shipping name, and are classlied, packaged, "
<br />inerxed and labeled/placarded, and are in at respects In empty corxfaicri for transport according to app to ‘riternational sea national govrivnental regulations. k. .4
<br />Generathes/Offercr;s Primed/Typed Name SigrFture Month Day Year
<br />`..'" e r-'4‘.." ,4X--,:,,:.-44--1.e.f.:-,.v.E...e.,....-5-c? .-,.r...,..e-f.e....., I 9.4 ......_,... , ..,:".‘,..,---Al.. i ,f; HA- 1,..7,e; _:
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<br />15. International Shipments E1 import to U,S. 0 Export fmrn U.S. ' Pert oi entry/exit. 5I
<br />Transporter Signature (tor exports only): Date leaving U.S.: irrER 16. Transporter Ad:nu/lodgment of Receipt of Materials
<br />.
<br />
<br />Transporter 1 Printed/Typed Name Signature /, Month Day • Year ,.
<br />..,:e...:;•';!G.,./....- w. ..57:5".2';.-.?:-/ i , I c•V I c$Ffj I • -- -k-'','--'-e' .- - ‘-'_'-'7•7:1r.l.v4._;:.)
<br />Transporter 2 Printuryped Name Sig6turo Month Day Yi:37,
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<br />17. DISCr2panCy --
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<br />Discrepancy Indication Spase r--1.
<br />L--I Quan4ly 0 Type ,_r: Residue Ei Partial Reec'don Full I:018,ton
<br />Manifest Reference Number
<br />..,,, •
<br />.,, -,-4
<br />- Alternate. Facility (cr Genera or) U.S. EPA ID Number
<br />Facility's Phone:
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<br />Signature of Altemate Facility (or Generator) . Month Day Year
<br />1 i
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<br />. . - .... . . , . .
<br />18. Designated Futility Owner or Operator. Cerligoaticut cf reuipt cf materials coventxi by the manifest except as noied in Item 17a .
<br />PlintedOrypectfiame , . _ ;, . Signatura Month Day Year '`.
<br />
<br />i . , ,. • r if --)_ „1_, i f ,--.: 1 . )_1 . - 1(4 la
<br />169-BLS-C 5 11979 (Flev;'9191
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<br />IRAN' SPbF1TE
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