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j\\4# 3062 70 LAtc it-2cnot-I 6 LfA4- (-1u1 <br />• <br />cc <br />NON-HAZARDOUS <br />WASTE MANIFEST <br /> 43 ''''nt.' <br />,^ 4 n 0p.-ioc,Plig <br />2. Page 1 ot <br />1 <br />3 Emergency Response Phone <br />‘4 ,1-3 1.1-211-1P <br />4. Waste Treoktng Number <br />1024930 P(' <br />5 (,eneiates Name end Wang Adtess Generator's See Address (4 ddlerant than marring address) <br />P34E MANIFESTS PACIFIC GAS & ELECTRIC, MCDONALD ISLUSF <br />P C BOX irysa 2i 21 ZUCKERMAN RC) <br />SAN FRANCISCO CA 041711 'STOCKTON CA C:5204 Go,vonto'sot.z./ am 7ai alrfQ <br />e Trumpeter 1 Convene Item U.S. EPA ID Number <br />• <br />PSC: If JCAISTRI AI, OLITS.:K IRCINCIAS r. A P f7 r11 !I .? 0 CI ., 6 R <br />7 Twomey, 2 COM," Plom US. EPA ID Number <br />' <br />I <br />I Deognsbat noisy No,w ana Sae AMP., US. EPA ID Number <br />US ECOLOGY. INC <br />mvw os, it ILELFS SC/ OE BEATTY <br />SEATI',' AN NOM <br />r lrt....mo,__23st.jav I ,! , T 7t, 1 n 11 1 n 1'1 CI 0 aciti <br />10 Containers 11 Total 12. Unit <br />Narne DeeeeMem 11 Waste POMP led Mn Type Quantity VrtNol. <br />NON RESULATFD 11C)110 (TRIFTHYLENE (NYCO) SKI) <br />) 0 1 U '),`Pi GO , <br />, <br />13 Selena Handeng Instruntare and Addroonal IMormalion r PPorn,r. t nirt,'4111,00-0 <br />175-2001-1.,i0;-‘1‘..'97; <br />It GENERATOWSOFFEROR'S CERTIFICATION: I hereby declare that the contents ol this constgriment are luny and accurately described above by the proper shipping name, and are daunted, packaged, <br />reeked and tatteleddlicadded and ore era! respects m proper conlibon for transport according to want* nterrabonal and national governmental regulations. <br />Grinenhof sOrtemt a Pratte:11)mnd N.trne *rehire Month Day Year <br />1 1 I ii 20 <br />- <br />15 intenwPonia Shipments 0 Export from U.S. P00 0! entry/eel. 0 Import lo U S. <br />Transrone• Signature (Ior eipOnS OnlY1 Dale leaving US.: [ DESIGNATED FACILITY I TRANSPORTER II Transporter daMe d7rr050IAeOedt!0!MatnnnA <br />Tramparter 1 PrarnelTyped Name Srgrature , 1.1 i Monet Day Year <br />I ‘A.A) ./Lnir Yrian-1.sroder 2 Prritedlyped Name— ‘ *Pat.. M Day Year <br />I I I 1 <br />17 DtaCtelkansl <br />17a DISC1PanC1 Indlcanon Space 0 Ossantty 0 Type 0 Residue 0 Paraal Rejection 0 Full Rejection <br />aniest Reference Number. <br />175 Alternate Facility (or Generator,U S. EPA ID Number , <br />Faddy's Finns, <br />17c SKrtaIore Of Alternate Faddy or Generator) Month Day Sear <br />18 Designated Faceny Owner or Operator Certification of rece ol matenals covered by IN merited accept as noted In dem 17a <br />Month Day Year <br />PotreellypeciNeete , <br />. \ L _I ---1 17-1 T (-- <br />Mr Tti 111%1CM-1117FR M1 <br />069-131_C-0 5 11977 (Rev. 9/09) <br />Scanned with CamScanner