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1.Generator ID Number 2.Pa e 1 of 3.Emer enc Res onse Phone 4.Waste Tracking Number <br /> NON-HAZARDOUS g g Y P <br /> WASTE MANIFEST +" t <br /> 5.Generator's Name and Mailing Address <br /> UnlFltat-FI�EI;N( JU! Generators Site Address(if different than mailing address <br /> 819 N.Hunlor;,t. <br /> Stockton.CA95202 <br /> f,,, ,,t <br /> Generators Phone: r-R;t4 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ADVANc. ,ICAL TRANSPORT LLC t..AKIL"�1 t1`�t1 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.De 'gated Nave and ate Address U.S.EPA ID Number <br /> Y(a1p C:outilvl ant�ii <br /> 44090 Covnty koa�i e8ri <br /> t VC10diansl,CA 1957743 <br /> Facilf 'sPhone: t530)66(-b"��► <br /> 10.Containers 11.Total 12.Unit <br /> 9.Waste Shipping Name and Description No. Type Quantity wt./Vol. <br /> a ' <br /> x <br /> w <br /> Z 2 <br /> w <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information fi9olo,,(1 f'it.N1'bgir 595E 6ep L3'OC!►tY ant II G7 14 <br /> t i 2024-866 EXP 7115/2025 I.iPJ`- ..�._ <br /> x <br /> � 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,packac <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 Printed/Typed Name Signature Month Day <br /> F- <br /> 15.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter Signature for exports only): Date leaving U.S.: <br /> W 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter F <br /> e Signature Month Day <br /> O 2 <br /> a t'4aTransporter 2eSignature Month Day <br /> Discrepan17a.Discrepae ❑Residue ❑Partial Rejection ❑Full Rej <br /> ❑Quantity El <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 17b,Alternate Facility(or Generator) <br />_J <br /> V <br /> uu. Facility's Phone: Month Dt <br /> W 17c.Signature of Alternate Facility(or Generator) <br /> Z <br /> 9 <br /> n <br /> U <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> Signature <br /> Month <br /> Printed/Typed Name <br />