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PONWO or.two <br /> NON-HAZARDOUS 1.Generator ID Number 2.Page7�1 <br /> mergency Response Phare 4.Waste Tracking Number <br /> 7t WASTE MANIFEST \ 00 - (O ( - <br /> 5.Ge tars Nam and Mating Ad Generator's Site Address pl different than coling address) <br /> Intravtsc ►'o vl <br /> 1`'t3 I �s t�iac'e.,S-k- S3o i °od <br /> Generalo7s�hon s G,.,�.-e ,zL l�sls C�irH) 6iS-ts (.tn�► �ew+�, CA <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> P -t' �n� m�, �l �s� I C�ktnds3 ---- <br /> 7.Transporter 2 Company Name I!_ ((�� U.S.EPA ID Number <br /> Vb v4y,."�`Tc�E �1 t_�y i C•-6 Lf Hxf-7 <br /> 8.DesignAled Flea Namete lyre. ss �� U.S.EPA ID Number <br /> 11b 1 or i /. I+,�,V v&k r <br /> Fadi a Phoria: '�� cA °t d8 CA 0a 0901 <br /> 10,Containers 11.Total 12 Unit <br /> 9.Waste Shipping Name and Description <br /> No. Type Quanbry WINd. <br /> C- <br /> Uj I <br /> _ PLO-, �F oda - _) <br /> 3 <br /> 13. Special ionsI '�Additional O <br /> 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby dedam that the contents of this consignment are fully and accurately dosoribed above by the pmper sf**g name,and are dasslfied,packaged, <br /> marked and Iabeled/ptacarded,and are in all respects in proper condition for transport according to applicable intematio al and national governmental regulations. <br /> Generrletors eror's Printed!Ty' mee Signature — Abrth Day Year <br /> _ <br /> a i- .Inter.'Umi ❑Impart b U S ❑Export from U.S. P try/exiC <br /> T Date leavink U.S.: <br /> 16.Transporter Acknowledgment of Receipt of Melerids <br /> Transport r 1 Pmted/T N Signature Month Day Year <br /> 0IL <br /> Tra 2 yped Name O Signature Month Day Year <br /> — 17.Discrepancy <br /> 17a.Discrepancy Indication Space 0. y ❑Type Residue:- El Partial R.lection ❑Ful Rejedion <br /> � >,. <br /> Manifest Reference Number. <br /> 17b.Alernate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facirys Phone: Month Day Year <br /> w 17c.Signature of Alternate Fadtity(or Generator) <br /> C I I I I <br /> z <br /> d <br /> LU <br /> IN <br /> 18.Designated Fad ify Owner or Opetatnr.Certification d rem d m covered by the marifesl except as noted in Item 17a <br /> Printed/Typed Nam S'nature Month Day Year <br /> f g <br /> _ �-- ,�%�� fir•/= __ _ _ _ � �,�i��, ��-.�;<'-_���` �:�^L%.� �'�. <br /> GC Lai g Printed in the USA �r_slars. ,r.0 '�CILI�r TO G(NF �pH ; Reorder Parttt MANIFEST-C6NHWC <br /> i.nnr%-QQ7 94ri? 913-897-6966 <br />