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NON-NAZARDDUS <br />WASTE MANIFEST <br />I. Generator 10 Number <br />WA <br />2. Page 1 ol <br />1 <br />3. Emergency flMonse Phone <br />877-2$64265 <br />4. Waste Trucking Number <br />2.2.266294006 <br />5. Generator's Name and MmTing Address Generator's'Site Adarisiadiffehtfrit than Mailing address) <br />.Muilielpa1 Pales Division <br />... <br />tiinerator's Phone: '. 209437,870.0 I <br />Crransporier I Company Name U.S. EPA ID MOW <br />7..': :` Ponde-Inviroarnenbl SeivIces ri- ;4444-9- 180737 . 7. Transporter 2 Company Name U.S;SPKIDUitliik <br />I. <br />idiotys <br />8, Des;gneted <br />' 4.Pbtiettilbiliiiir.1. <br />1' .4(Prfa5-P:- <br />' i,.5.17.4iiiiiitif <br />Facility Name arid Silo Address U.S. EPA 10 <br />ifitiO.iiilbill,;:r" • <br />.*CAlt.4585.- <br />phone. -, -''''-,-,,,'ff-7,.''. ' ' 707-432-467 . Vetkitit#0./iiti.**, <br />Number <br />45-;• • <br />g: yiasii shot Name #1 ., Description . 10 contakto 7! 11; ititta <br />Quantity <br />i <br />Vitt/ <br />141 <br />Ro Typf <br />414colitorilotisWeste SoliclAtfydrombon mpacted So <br />'1Z,70 ,i.... ..i.:„ .. <br />2. <br />..•5 -- <br />^`, ii .--• ...s. <br />1".• <br />''/ i <br />II <br />13, Special.11 . Instructions and Addtional Infermatien <br />: <br />P0105268.1t- : <br />lotaF26.020 -- <br />141 DENERATOR'S/OFFEROR'S DERTIFICAT1ON: 1 hereby declare that the contents of this conSignigent ,are hely and accurately described above by the proper shipping name, and areclaa.s1Ged, packaged, <br />..;:, iilarked and tabereq/ptipfdo, 00,4403n;4frespecls in proper condition for transport accoidIptdlmpticable intern:Won and national govenurtenhe regulations. <br />. GlineretorslOtrarofs Printed/Typed Name ,..; .ignature 2— _.....-29'11 Month" ilitsA.Viie <br />De) gg Z..es 5 <br />F <br />.— <br />E <br />I_ <br />z z <br />.P• <br />t5. InternafionattlhieMente III , — , • Impart lo U.S. ID ExPort from U.S. porter enWait- <br />Transporter Signature (tor experts onW: DAM leaving U.S.: <br />1,1k.TiallePoder AckOredgitent of Receipt of-Mi.48fals <br />Tfairmorter I Priniecnyped Name _ SiElt.tra,.:2 . .. Month <br />g <br />Transporter 2 PrlifteillTyp%1 Name Sinaloa . Month -DIY Yi6 <br />I I . I • DESIGNATED PACILItt .01.50/Parcy <br />17a. Diserefiancy Indtcalleh Space • Quantity Type Residue Partial Rejection FtATD.qjectfor1 <br />Manifest Reference Number <br />17p. Alternate Facility (or Generator) U.S. EPA 10 Number <br />Facility's Phone: I <br />17c. Signature of Alternate Feceity (or Generator) Month <br />I <br />Day Y <br />• <br />f;-•: <br />4.i.x., <br />18, Designated Faciity Cnsner or Operator ConitIcal • • ol receipt of materials coveted by the terifest *apt as bated frt Ilan 17a <br />PffitetTypel None SIgilaturo <br />, <br />n <br />i• 4 <br />169414-0 6 10498 Met 09) <br /> <br />GNATED FACL,tTS G EWAT