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•-W - <br /> NON-HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Wade Tracking Number <br /> WASTE MANIFEST CAL000316nill 1 =J-424-000-0-� E- 09 <br /> (� <br /> 5.Generators Name and Mai4ng Address Generator's Site Address R dMlcrent than mating a ressl <br /> CENTRAL, SPRING,INC. <br /> 1619 BOEING WAY <br /> 5T17CICTON.CA 95206Geteraors Prion: Q83-1 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> FREW)UW ENVIRONMENTAL SERVICES WC Phone 0800.554+-3274 (AR0001 71011 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 21st CENTUR'V EN IRONWiNJAL LVt4Q4EMENT OF NEVAD&LLC CAROOf?1ti4O12 <br /> 6,Designated Fee"Name and Site Address U.S.EPA ID Number <br /> 215T CEKRMY EMI NM0980895338 <br /> 2096 NEWLANDS DRIVE. EAST <br /> FERNLEY,MI 99408 <br /> Fadi 's Phone; 17S57�Z7dU _ <br /> 9.Waste Shipping Name and Description 11.Taal 12.Unit <br /> No. Type puanlay WtNal. <br /> 1 Non4lemrdctiis Write ScAd (Bead Blast Powder) L]M 1'1M P <br /> z <br /> eu 2. <br /> 3. <br /> 4, <br /> i <br /> 73- Handling Instructions and Addihonai Intomvation <br /> IiteFtidiers to be 4tNv TraOied and waver PPE <br /> 1 l a):kikt24t3[XU G X <br /> 14.OPERATOR'S CERTIRCATiDN:I certiN the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> ratorslptP e PrinlecVTypy Netrce SignatureL {*• Month ++Day Year <br /> �rir ► ��Its It ffl �-->r .. YL ! <br /> 15.International Shipments <br /> jr ❑import to U.S. ❑Export hem U.S. Por[of enhyle:it. <br /> Tran rter S nature fore its only): Date leavm U.S.: <br /> s 16.Transporter Acknowledgment of Receipt of MWerift - <br /> W <br /> Transporter 1 Printed/Typed Name Signature _ - Month Day Year <br /> OlJ"1 <br /> CL RfFt:tmn, =�I <br /> dransporter 2 Pnnfedlryped Name Signature MothDay Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑puanliry F]Type ❑ae5idue ❑Partial Rejection ❑Full Refection <br /> Wannest Reierence Number. <br /> UT 17b.Alternate Facility(or Generator) U.S.EPA 16 Number <br /> 2 Facility's Phage. <br /> 17c.Signature of Aeemals Facility(or Generator) Month Day Year <br /> II&Designated Facility Owner or Operator:CegiGcatiaF of receipt of matenats covered by the manliest except as noletl in item 17a <br /> PrintedFTyped Name Signature Month Day Year <br /> 169-BLC-0 5 11977(Rev.81136) GENERATOR'S/SHIPPER'S INITIAL COPY <br />