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j NON-HAZARDOUS 1.Generator ID Number 2,Page t of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST \ V 00 (A 'ZA930 0 2—`1 ? 61 O V3 <br /> 6,Generators Name and Mailing Address Gmmralaea Site Address(it different than maling address) <br /> C 2 �aCa $ �a a iC tY) J -ter rvti4ls:� Te 3 ri-& S V6 kIL of ce^rnin�c <br /> Wo '3003 Mawy Dr <br /> Generator's Phone:$O'n�l �'`� Cf� Q kA �- �fj{.� cl7 3 ) s��fPsm N 5701 <br /> 6.Transpo or 1 Company Name U.S.EPA ID Number <br /> �i'1 0� 6vt1Z,\ PAC!-, tin l SEhl;t C' C� O 0 0 3_S 1 '1 Cs <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8.Designated Facility Name and Sits Address U.S.EPA ID Number <br /> wc\Ytelv�q,nr}2r�t,�i- KaN� <br /> 3S 2 Si 01c1 J'icyla�� rA <br /> Facit s Phone; Ect-tNtr�.r.nt c:�'hj r v4 'I 2 �� c^�•G) C A'1'Q 0 d 6 q t 4 <br /> ✓9.Waste Shipping Name and Descdptl 10,Containers 11.Total 12,Unitan No. Type Quantity WI.Nol. <br /> 1 to -i{hZo�':Jlov41 �.7 / 4`�w�(4 Cln;wber� <br /> �ctife1l F F. �q%AA Cool t°C <br /> LU <br /> a <br /> 4. <br /> Q <br /> 13.Special tfaMfng Ir mt _daps and Additional Information <br /> s -7300 6A u+H �, 4rrg � 3 <br /> ,b \z 3 <br /> 14.ME ERATOR'SIOFFEAOR-S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping ne,and are ciassTied,padmged, <br /> marKad and Iabele oacanfed,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Gams es'Offerces PnMed Typed Nana; Signature Month Day Year. <br /> F 15,tonal Shpmems ❑import to U.S. ❑Export from U.S. Pod of entrylexit <br /> 1 ? Transomer Siarzwre(for exports only): Date leaving U.S.; <br /> r¢ 16.Tran mo sporferAdvriedgment of Receipt of Matadals <br /> Trasponer PnntWyped Name // Signature <br /> !�� Month Day Year <br /> b'. <br /> QTrarzporier2PrimedlTypedName Signature Month Day Year <br /> 2 <br /> t- <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> 9/a��/"y,na" <br /> �n❑`Type � esidue/�/^ Partial Rejection Fug Reletifim <br /> Manifest Reference Number. VVV <br /> ? 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> FacilitysPhone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> w <br /> I c <br /> 18.Designated Facility Owner or Operator:Certification of receipt of matedals covered by the manifest except as noted in Item 7a <br /> Primed i ed area � A Signature Man Day jar <br /> L—iming ('/•Ly <br /> 169 BLC-08 10498 ev.9/09) ESIGNATED FACILITY TO GENERATOR <br />