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GENERATOR 111 NON-HAZARDOUS <br />WASTE MANIFEST <br />1, Generator ID Number <br />ET ?q: t - ,'..1 T <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />1.. • .-:!•:?.-1-..-.. ': e-.-- <br />4. Waste Tracking Number <br />p.eilc_otrisi4IggigtftIng Address Generators Sits Address Of different than mating address) <br />IACIFIC GAS &ELECTRIC - <br />F.1-..). Pr."))( 7610 .• \ C9 \ \ 1\1\CNS \?ef'(;\ ‘\—t FPAr^i (ISCO ,I'.0 CA ‘ -- _ <br />oenenhoes Phone: SOO 321- 103C e) t oc \(- \c.'' ON CI `, ' ) 0 ') . -- - ., <br />Transporter 1 Company Name U.S. EPA ID Number <br />L 1 Hril..F-1::1172.! AI . C•Ln.-8'..L'UiTh,-:'!Nc:.3. .•-, F.:. 5 <br />Transporter 2 Company Name U.S. EPA ID Number <br />°. a <br />Fad' <br />1.41::,'Y'.'0 (,)f) <br />ItreAtillV AtIMMAL LIE <br />U.S. EPA ID Number <br />CI -FY C.A 9606? <br />r7„Fi yr y's Phone: iF:iir :T. 5,i i ..), _ .„ _ _ _ .: ))) ,i1 <br />9. Waste Shipping Name and Description <br />10. Containers 11. Total la Unit <br />No Type Quantity Wt.Nol. <br />t 0 0 <br />, <br />13 Special Handlino Instrtcnos and Additional Informal-am <br />P k(T I l't it ¶00 — \\ 1-1 S— . <br />14. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable international and national governmental regulations. <br />Generator's/Offeror's PrIkedIT Name Salq <br />e_t.\. \ / \ o <br /> <br />/ 1 kir Day i. Year <br />'-- <br />I C I V‹ I ''' \ • 5 I i 11 <br />,i <br />r— <br />1 15. International Shipments El [mood to U.S. I Ekon i from U.S. of entry/axle <br />Transporter Signature (for expons only): a leaving U.S.: 'TRANSPORTER 16. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Pretryped Name \ <br />\ <br />s.," , Year -- -- tfon Day Ye <br />I l 'f i° <br />__,,--- <br />I Il',; )-- `• <br />Transporte2iPrinted/Typed Name Signature Month Day Year <br />J I I I I -4-- DESIGNATED FACILITY 17. Discrepancy <br />17a Discrepancy Indication Space <br />Quantity Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number. <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: <br />Signature of Alternate Facility (or Generator) - Month Day Year <br />18. Designated Facility Owner or Operator: Certification of receipt of materials covered by the manifest except as noted iti lire ii- <br />Printed/Typed Nre Sikalt.:sa -- <br />) <br />Day Year <br /> <br />. \ <br />100 <br />\ \a(a: i ( -- \ \ • 1.2 (Ai I I 3 I <br />169-BLC-0 5 11977 (Rev. 9/09) <br /> DESIGNATED FACILITY'S COPY