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NON-HAZARDOUS 1.Generator ID Number 1..�Page.I of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST C A D S 8 2 0 3 0 2 0 7 G�1, 888-877-7287 0 1 1 2 0 8 - 0 0 1 <br /> 5.Generator's Name and Mailing Add-ess Att: Manifest Receiving Generator's Site Address(if different than mailing address) <br /> Union Pacific Railroad c/o GHD Union Pacific Railroad <br /> 6520 Corporate Dr. 833 East 8th St. <br /> Indianapolis IN 46278 20 204-7007 Stockton,CA 95206 <br /> Generetoes Phane: <br /> 6.Transporter 1 Company ame. U.S.EPA ID Number <br /> 7.Tr nsporter 2 Campany Namef ` . r C U.S. PA ID Number <br /> VV+ Vl eA'()M q6q6t 9 <br /> 8.Designated Facixty and Site Address U.S.EPA ID NLrnber <br /> Crosby&Overton . <br /> 1630 W 17th Street <br /> Long Beach CA 90813 <br /> Facit^'s Phone: <br /> 9.Waste Shipping Name and Description 10.Containers 11,Total 12.UrA <br /> No. Type Quantity Wt.Nct. <br /> a1.NON HAZARDOUS MSTE,SOLID.(ABSORBENT RAGS/WIPES) A <br /> W • , Dtv1_ P t_.. <br /> LZ 2. <br /> f <br /> 0 <br /> 3. <br /> 4. a.. <br /> 13.Specia!Handling InstructIms and Additional Information <br /> Sob# 11-22-00484 <br /> WR# ll20a <br /> Pro 22-1nq <br /> Profile(3) : 124051 6 <br /> 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this con ignmen are an accurate y descri above y p per s ippirig ne-Jame,and are c asst led,packaged, <br /> marked and lab&d/placarded,and are in all respects in proper condition for transport according to appllcable international and national goverm)ental regulations. <br /> Generator's/Offeror's Printed/Typed Name Signature nth Da Year <br /> 15.International Shipments <br /> Import to U.S. Expcct from U.S. Pcrt of entry/exit: <br /> z Transporter Signature for exports only): Date leaving U.S.: <br /> w a <br /> 16.Transporter Acknowledgment of Receipt of Materi <br /> Transpccter 1 PdriedrTyped Name ig lure Month Day Year <br /> <11 <br /> zTransp e 2 PrRed/Typed Name Signature Month Day Year <br /> cc <br /> IVL �� �� �Y2 2121- <br /> 17. <br /> Discrepancy <br /> 17a.Discrepancy Indication Space ❑❑ Type Quantity yyn ❑Residue ❑Partial Rejection ❑Full Resection <br /> Manifest Reference Number: <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> L, Facikty's Phone: <br /> w 17c.Signature cf Alternate Facility(or Generator) Month Day Year <br /> zz <br /> -f��.< � ,.�,:: �,`•�� � '`. g ". .,;� est ,�,`''t <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> Printed/Typed Name F C c Signature N4gCth � Year <br /> 169-BLC-0 5 11977(Rev.9/69) DESIGNATED FACILITY TO GENERATOR <br />