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<br />A NON-HAZARDOUS
<br />L. WASTE MANIFEST
<br />1. Generator ID Number i 2, Page 1 of '
<br />KIT Arl.ri.=BLE LI
<br />3. Emersoncy Response Phone
<br />67,/e0..5-63 - 77 70
<br />4. Waste Tracking Number ,. , r.., ,
<br />1 i ti 0 ,.1 12
<br />..- 5. Generators Name and Mailing Address Generators SeAddrew (if different then trailing address) -
<br />fiti .-- AZ V'.e.- "--i7as'-'7%/606,S45 77a,e. ict ?J6- ,,q,-,:gie-Ae;"-//evAt Y F9/ r,e..6.5 ,Wf.,7- ze)51/ S. ..---",?,:n 6.5.7- ...f.'.4 iec-tc,/,' .'' c, t/,•,<.i>A1.,..5.5 /A:./ A"ier/1.7- i i 47 c?..f.>'7= -5-')/44/4".di... : --.9,'-' 7:04 Oci : N Co • , c- 4 I Generators Phone:4.1.../, 5:f..,A..17-,: ' t,- , E. Transporter 1 Company Name US. EPA ID Number
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<br />7, Transporter 2 Comary Name ...,..„
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<br />U.S. SPA ID Nu*.>,r
<br />I NOT APPIXAVJE
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<br />. .i. D:s.;grt-ato Facility Name and Site Ari..d:m - .. - LI.S. EPA ID Numb&
<br />RECOLMY KAY RC14„.c..., MT A.P.PLK;AS. Lii-7
<br />5426 HAy ROAD - VAC-AVILVE, CA 9M7
<br />Faciay's Phone. 737.) 672,471$
<br />I--
<br />iipping Name and Desengion 'to. Conialnars
<br />- Na. —`1
<br />11, Total
<br />Quaritty
<br />12. unit
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<br />14. GENERATOR'SIOFFESOR'S CERTIFICATION: 1 her,2i.ri r.iectate th41111,, corr-cer.b of this caisignmea-. t are fuliy and aw.retety derisgUt al..,"'ve bl rx prwer shiPPin9 narrle, end are cta ssit ed , pckKio. madied end labeledlplacarded, and are iA at respects In proper condition for transport acc.erding topitcaleje international aid national _gOnfrneatai ;VjatOaS. L N.
<br />GenaratorsiOfferoi's Periled/Typed Name Scra1ore Month Day Year
<br />i ,...-4' ./ • , .•-; ..a. ”" -:_i .1.`„‘4,- . ,,,..---7^,^ .1.-../.1.7.` .47-f.'412 .46.,14°- I .f..c.;Afft.-40, 1_ e...-.- 7:4,....2" 9 1 / I ''';'
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<br />15. Inteination Shipments -
<br />0 liroort to U.$. 0 aeon from U.S1. Port of entry/exit-
<br />--,-- Transporter Signature (tor sports oniy): Dale !miring U.S.: •
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<br />x 16. Transporter Acknowledgment of Rec.eipt of Materials •
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<br />1 r-nsoorrer 1 1,r'"ted/ i_ "pod Name Stnalors. Month Day . Year . , ...,- • / i
<br />1 I / 1._,..4 4":- Z7.:.-"--.,Aqtr,,,:al i #7!
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<br />' raftSpvrer2 Printeifiyprnd Name S• kire •Month Day Yoar
<br />1 - 1_ J. . _1 A I - 17. Discrepancy •
<br />•
<br />r-1 Discrepancy Indication Space
<br />Irk: Quantity E Typo .J. side!) E-1 Pardat Rejection 0 Fut l.„_Rejection
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<br />— Manifest Reference Number: '
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<br />4,
<br />Alternate Facility (or Generator) U.S. EPA ID Number 71 5 .
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<br />
<br />Facility's Phone: 1
<br />LI Signature of Alternate Facility (or Generator) ' Month Da, Veer
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<br />.g., 18. Designated Fadlity Owner br Operator: CleraFwtion of receipt oi material:. CO nrcd by trio man!fest e.)=1,-,t as notaci h hem 17. . _ ..
<br />Printed/Typal Narn4 i Signature ' Morith Day Year 1 r
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<br />, ,.- i, I .• ' • t ,•-• 1 r-1 I :a 4->, 1 -7 -1-- •-•-• , . .- ' `.. , 1 !. ' i6-BLS-0 5 11 (Rev. WO%
<br />TRAINS -#1
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