Laserfiche WebLink
NONHAZARDOUS I 1.Generator(D Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOTREQUIREED 0701566 <br /> 5.Generator's Name and Maging.Address Generator's Site Address(if different than mailing address) <br /> SP AW Coast Pn XkNft 2806 w Be*n i 1 Holt Drive <br /> paw eo1IS Sfouktca,CA V5M7 <br /> GeneraIMMAIlikCASIOM <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AflfedWfi h* fed Alokmm W CAINIM148M . <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> kw"kw <br /> I 106 C Akpat Road es Not Requked <br /> Facili � Q <br /> s Phone: Rio <br /> ,CA r 1 707'37443W <br /> 9.Waste Shipping Name and DescrlpUon 10.Containers 11.Total 12.Unit <br /> No. Type Quantity Wt1VoL <br /> Q NorMaZarlbW Mde LkW(PUW VAW) 1 tr"' 3 <br /> W <br /> Z 2. <br /> W <br /> C4 <br /> 3. <br /> 4. _ <br /> 13.Special Handling Instructions and Additional Information <br /> V*ar pnif 4*ft equipment whits hanxftq. 1fftt is or vokows as <br /> swo0wie. 24 hour*nwgwM mw*w(W)424-NW <br /> Chen w.% .,_-.r P%ieot g: 73048 <br /> 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accuralgly described above by the proper shipping name;and are classified,packaged, <br /> marked and labeled/piacarded,and are in all respects in proper condition for transport according to applicable intematienahand national governmental regulations. <br /> Generatofs/Offerofs PrintedfTyped Name - Signature - Month' Day Year <br /> /.b"/ls!;d•7 „r�'rr.r,r ?ip� 't.> .r�',,� d�� l'.:. ;/�::T'� /J✓'. it•it'. ,Ct- 1 I.'�11Z f�-•� '�. <br /> -i 15.Intemational Shipments ❑import to U.S. ❑Expod from U.S. Port of entryl.At: <br /> Transporter Signature for exports otrf : Date leaving U.S.: <br /> LU <br /> 16.Transporter Acknowledgmenl of Receipt of Materials <br /> Transported Printed/Typed Name Signature t ,._ y:= Month Day Year <br /> a Transporter 2 Pdnted/Typed Name l. Signature Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy indication Space ❑Ouanti ❑Residue ❑Partial Re action <br /> ty ❑Type j ❑Wg Rejection <br /> Manifest Reference Number. <br /> 17b.Alternate Facility(or Generator) U.S.FPA ID Number <br /> U <br /> w Facility's Phone: ' <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> c7 <br /> W <br /> O <br /> 18.Designated Facility.Owner or Operator.Co ilication of receipt of materials covered by the manifest except as noted in Item 17a. <br /> Printed/Typed Name Signature Month Day .Year <br /> 169-BLC-05 11977(Rev.9109) TRANSPORTER#2 <br />