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r <br /> NONHAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone A.Wa BTMd ft NalbW <br /> WASTE MANIFEST D(E1+IPI 1 1.8001424-9136 11-17-00f70�I M 15323 <br /> 5.Generators Name and Mailing Address Generators Site Address(6 different Man maaalg address) <br /> A_S H. TRANSPORTATION LLC. 2150 FORTANA AVE STO CKTO�N CA-95209 <br /> P.O. BOX 305 <br /> MCFARlAND CA 93290 <br /> Generators Phone: <br /> 6.Transporter i Comparry ame U.S.EPA ID Number <br /> PATRIOT EWARONMEN AL SStVM CAD0531B66799 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Des Ited FadIq Name and See Address U.S.EPA ID Number <br /> WASTE MAMM,'B6CiiT-ALTMKW LANDFP A RESOLMM RECOVERY FAl7L TTY CAD01382732 <br /> JONG ALTAMONT PASS RD <br /> LNERMORE CA 61551 <br /> Fed s Phare: <br /> 10.Containers 11.TOW 924455, 12.UNI <br /> 9.Wase Shippng Name and Desmpeot No6ly. Type OuanWtNol. <br /> 1. NON HAZARDOUS WASTE SOLID(SOIL ExGVATED FROM DIEM SPELL G 0 1 cm O I,3 <br /> aaw LIP) <br /> W <br /> W 2. <br /> 3 <br /> 13.Special Hanam msncams and AddfiaW Imormanon <br /> USE PROPER PPE pROFRE#633908G TO8811-17.00170 <br /> 10.GENERATOR'SIOPFEROR'S CERTN-TCATION:I fsreW declare that Me cadems OI Ms wrsignmem are fully and a rely deso bed"I'm by IN proper shWpng name,and are dassi50-laackeged. <br /> madred and sbeledNparamed,and are In as respects in proper eonditim for nensPon accD dM to applicable imemetional and nations govomrreNal reguWoonS. <br /> Genaramrs/011era's PnrdrrdlT Name Signature MmM Day Year <br /> J 16.Intematbrel SOipmems ❑Impod to U.S. ❑Export hen U.S. Pat of army/W: <br /> Transporter Signaaare Itofe Dale U.S.: <br /> 16.Transporter ACWrowledgment of Receipt d Malf)" <br /> (My YW <br /> T 17Y Month 1 <br /> M0 J S ::a�)Y Sra�\ryr�.�..ti- Month Day Year <br /> ? TranspOeer2PrededTyped Name <br /> V <br /> F7 17.Discrepancy <br /> 17a.Discrepancy htdce8an Space ❑ ❑Type ❑Residue ❑Penal A*c6al ❑Full Ra)edon <br /> Marxlest Relermce Number. <br /> r 17b.Alternate Fadley(a Generalorf U.S-EPA 10 NaMer <br /> CJ <br /> Fwlilys Ph": <br /> w 17 Signahae of Altemate FadMy(o Generator) Menlh Day Year <br /> a <br /> z <br /> us <br /> W <br /> O <br /> 1 18,Desgrseled FadRy a0psrelm N reulq of mate"mvmed by Me mantes except as noted in Item 17a <br /> Print yped Name Signature Mr/ �y <br /> 169-BLC-05 11 (Rev.9l09) TRANSPORTER G1 <br />