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N0N4L4WD0U5 1.Ganeretor r0 Humber P.Page t of 3.fntergeny Aesponsa Phone 1,Walla Trackln Humber <br /> waste MANIFEST WA 1 � �~----- <br /> (87T7 2�S&8285 '� '� 7Q� --003 <br /> S L3ene ci fc Hama end Mal Irsy Address Gertaratcea Site Address 01 lERewl than maifvig address] <br /> PaC1�C Ethaflal <br /> 3028 Navy Drive <br /> Gertara; <br /> Stoo e ,CA 63208 <br /> ur <br /> KT:,"Wier 1 Cemp"Name <br /> U.S.EPA ID hurrber <br /> Pander Enyironmeftal Servioes Ino f CARD00180737 <br /> i <br /> "or 2 Camparry Norm U.S.EPA Iq Number <br /> Il,D"onalad Fad;,y harm and Site Address � U.S.EPA ID Number <br /> Potrara Hills Landf l <br /> 3875 Potmro Hils Ln <br /> Su isun Cir, CA 94585 <br /> Fspli sPhone =1432822 <br /> 9.Waste Seto"Nwe and Descdptldrt 10.Containers f 1 Tclal 12 Wit <br /> _ No- Type cW" w-Vd <br /> Non-hazardo us waste, kquid (rinse watery 001 TT �'ZCc G <br /> T f <br /> 13.Specie!Hudkv InS1n1C ww and Amuc--j In'armaW <br /> Profile PHLF-17-137 Truck# LI <br /> Job#17-10036 <br /> 1 A.GENERATOR'SrQMRDA'5 CERTIFICATION:I hereby declare W1 the conterds of&s rarslgrrnerr are 10y and aomraivy described above by the p" strppN na.'ne aM are dasssired packagd. <br /> marked erd labeledlpiacerJed,and erg In all respecis in proper ca ddm Ior Irrutspon exard;ng to app ica*Intermeliorsal and national g4.-owr*ntas mgulalkrs. <br /> Genu tar OO fer&s Printedffyped Name $Eg ahrre morin Year <br /> G�1 ih a 3 i !7 <br /> 1S-lMrnaJmers <br /> orul Shpr <br /> El[.Ponn U 5 ❑Expod Ir, Ur—; <br /> Port of entry,W _ <br /> Trar.rry:riot nah,ra jfv 9n711 qwt ':_. Da[al±evi�U S.. <br /> ¢ I&Transpolar AbviowledgY nt o!Recalpt of Materlaq <br /> Transporter S PT'Frryped Nam. S'Qnaiura __ Mmth as Year <br /> r 1q A7 <br /> TranspDrter 2 Pr' edfT ped Name �yw f, <br /> � it Day Year <br /> 17.Discrepancy . <br /> 17a.Discrepancy Indicaden SpaceON- -- <br /> Y ❑Type ❑R-I`due ❑?anal Roleclion ❑FU Reiecdon <br /> —_ Man4est Aelererra Nu,rber <br /> 17b Mernala Fadty for Generator] - — U5.IPA JD Humber <br /> I-7 <br /> iL rad:*s Phone r <br /> 1%57awm of Altemas Fadity(or GsrvaW — Month Day Year <br /> z <br /> 4� <br /> m <br /> W <br /> O <br /> 18.Designated Fadlly Oww or Operator CeafflW n t of materials covered by the marOw escapi as noted in f*17 <br /> Pdnredffyped Name Sf¢vlure rT — r <br /> 1619-BLC•0 5 11877(Hev.9109) DESIGNATED FACILITY TO GENERATOR <br />