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NUN-HAZARDOUS 1, Generators US EPA ID No. Manifest 2. Pogo i <br /> WASINMANIFEST ANi�' Document No. <br /> �riIFESr '• �` � 3� c of i i.t �` ,I <br /> 3, Gmnorator's Name and Mailing Address <br /> a.k F'.i�--L,F', ,. <br /> lli�► ' IvyI& r."f I,?Mdw;Y r'Cr. <br /> b. t'enCrpfprrsi <br /> 5, Tronsporter T Company Name 6. US EPA ID Nvmber A. Transporter's Phone <br /> ltl.h"11!r^t !'' �cr';1,n,t "f..r{ .:i,. �c, Y ti .r; L T �....._. . '_►_u.�u?';'�—�# 41 <br /> 7. Transporter 2 Company Name $. US EPA 1D Number B. Tronsporscr's Phone <br /> 9. Designated Facility Name and Sitc Address w 10. US EPA 10 Number C. Facility's Phone <br /> µi <br /> Contnpr,y -'13. 1 d. <br /> 11. Waste Shipping Npmsc <br /> c and Dem 12, Total unit <br /> Na. Type Ouantit wt Vol <br /> p• 64on--kPAVir6u)pt k4iiSCA?S" _,hd <br /> b. <br /> E <br /> N <br /> R <br /> A <br /> T' <br /> 4 <br /> R <br /> D, Additional De�ceip;ions for Motoria9sfisted Above E, Handling Codes for Wooeb Listed Above <br /> 15. � <br /> Special Handling Initructions end Additional information <br /> T?►liE3k�yt�. <br /> 4 t-ffAJN k V(z't;Ykti 2 Ni.rM6&t (,;J4Wvt'4i4X 1-6U0—4 <br /> w i'1'! Atli}} s�'. . 2y41 . Nave <br /> y Dr: Stock:tart,. CA 1��. + <br /> 16,GENERATOR'S CERTIFICATION: I cemify the motodok davulbed above on this moMosl ++uq not wb}ev to fades} repulatiore Por rop"Ao.prgpnr dkpeaol all Moxordovs Waste, <br /> Primod/Typed Narne _T Sgnoture"e Month Day YFa� <br /> T 17,Transporter 1 Acknowledgemcn;of Rc,;ejpt of Materials <br /> A nfed/Typed amg Signatvrb f ' vn pay r <br /> P f Sir T _ <br /> 0 18.Tronspvrtcr 2 Acknowledgement of Rccoipt of Matenala <br /> T Primed/Typed Name N SiQnatvro r <br /> Month Day Yvar <br /> E <br /> R <br /> 19.Dihcrepancy Indication Space <br /> IF <br /> A <br /> C --- <br /> L 24.facility Owner yr Opt-otar. CertiReation of receipt of wo4e materials covered by this rnanifexf except as noted in Item 19. <br /> t <br /> 7 <br /> Y <br /> Prinf¢d/Typed Namc Signature Month Day Ye or <br />