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t-• — 1 <br />P <br />NON.HAZARDOUS <br />WASTE MANIFEST <br />I. Flix"D Number 12. Pagei of 1 1 EmerliVelyaks 4. Vjeste Tr.sqltql-nber 22-.ZAMY29-V001 <br /> .r. <br />1 <br />5, Gertfliieht qe V. 41161,40irtip81 Utglifes DivisIon 745 west a....: I. St <br />SEockton CA 93206 <br />209-937-8700 Generator's Phone: I <br />Generator's Sire Address (I1 different than mailing address) <br />ix <br />cr, ..1; <br />, T <br />„ it> <br />,-7 <br />6..TwfitatIrcaiworaentat Sesvim u.scExwayti 8 0 7 3 7 <br />r <br />7. Transporter 2 Company Name (is EPA ID Number <br />I <br />- <br />Facirli <br />4... Petiaiteiractil*Mair „Address U.S. EPA ID Number <br />3673 Potogo figs lat <br />Suisun city, CA 94585 <br />r's Phone: . 707432.46717 - I CAR-0,0008.9.44.6 <br />., . <br />v <br />wo <br />9. Waste Shipping Name and Description 12. Unit 10. Containers ii. Torai <br />140044161.41)te-Wastt-50114(flydrocarbolvtivptettd-Ve-- to, i . plionlq wvviorl, <br />1- !C <br />Ce <br />W <br />Z <br />.gepatkm) S . <br />i <br />3 0 3 <br />1 <br />t, <br />.,, <br />W 0 <br />• <br />L <br />• <br />, <br />i• <br />A <br />13: 4144,8teiguripApzi943rilAdditional Information <br />.1.14140.Z.q60429 g <br />Si AW <br />.2ft, 14.. RENER .A'S/OFFRROR'S CERTIFICATION: ereby declare that the contents of this consignment are fully and accurately described above by Ma proper shipping n • ;it are classified; packaged, mat arid lab dtplacarded, and are In at re cis In proper cone:lion for transport according to applicable International MO national govern en , • elegem. , ." <br />ne oils Printed. ad Name <br />Z <br />Signature ArAlly:4111W j - Day Year <br />-t t- 5: Internalltingl Shipments 0 neon to U,S, Export from U.S. Port of • ry/exII: Ail -.• Transporter Signature (lot exports on): Dale lea U.S.: :a Eci 16..Transpoder Acknowledgment at Receipt at Materials <br />I-- .ca. T ler 1 P . 0 ed Nome Signature .400. pay Year <br />arailliro t. 7-, <br />r, , <br />' <br />< <br />1— <br />--- .. TransOler 2 Printed/Typed I ante *nature ' *nth. Day Year <br />I , 17, DisCrepancy <br /> 1 175. Discrepancy Indication Space I aliantity fl Type 0 Residua 1111 Partial fleisection Full Rejection <br />Manifest Reference Number: <br />, <br />r <br />a <br />, a <br />a. <br />Alternate Faaty (or Generator) U.S. EPA ID lloniber <br />. . <br />Facility's Phone: i , <br />I- 4 z (5 ,, <br />Signature ol Alternate Facility (or General9n Month Day Year ..? , <br />ko ; (7) ur m <br />18 De ignated Pocnity Owner or Opotaior. Coniticetion a ,..3 coca' lair rels covered by Me manifest except as noted in tern 17a <br />i <br />AIN PlirlledirYPed Nome . Signature vy iv, <br />_... <br />XIii-ATED FACILITY TO GEN EFIA''fb; 169-BLC-0 6 10490 (Rev. 0109)