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2.Page 1 of 3.EmI mcldn9 Nmnber <br /> -HWse117-NON•HARDOUS 49136 <br /> 70,61N n 15293 <br /> WASTE MANIFEST <br /> 5.Generators Name and MMMhg Addros 6esn15 Bite NTAN (A VF S than TON CA 195) <br /> ASM.TRANSPORTATION I1C 7150 FLyFlTANA AYF 5T13L'KTON fJs A5209 <br /> P.O. BOX 965 <br /> MCFARLAND CA 99250 <br /> Ge errnaSw�esddeePhow 6613726342 LLS FPA ID WWM <br /> 6. <br /> To <br /> PATRIOT%MMMMENTAL SERVICES CAD0536fi M <br /> 7.Transporter 2 Canpany Ram U.S.EPA m feaMer <br /> 8. led Faace�yy Name BrhO See AddresU.S.EPA ID IAmber <br /> WASTE MANACB4FNT ALTAMONT LANDER 16 RMN IRCF RfCX)VERY FAs11STY CAD981302M <br /> 10640 ALTAL40W PASS RD <br /> LNERMORE CA W561 <br /> Facild es Phene: 92545S7305 <br /> 10.rorveien 11.Total 12 Unit <br /> 9.Waste Shipping Name and Deson on No. Type quantity WtNol. <br /> ¢ 1' NON HAZARDOUS WASTE SOLID(SOIL.EXCAVATE RtOM DIESEL S14U _ ,. t CM , <br /> CLEAN LP) L 1 Y <br /> w <br /> W 2. <br /> 1 <br /> 4. <br /> 13.Special Handing Instructions and Addtionat Inkrmabon <br /> USE PROPER PPE PRORLE#633408'Clt 106#11-17-00470 <br /> 14.GENERATOR'SIOFFEROR'S CERTRTCATION:I hereby declare mal the contents ol this carsipranent are hAY and aomrwetv descnbed above by the Prover slippng name.end are classified,paokaged. <br /> marred and labe@o by rded and are in al respectS h Proper mndibon tar transport according to appacable htemar onw and natbnal govemmenml mgulawm <br /> Generames08emes Pnnledlryped Nem, Sgnahne Monro Day Year <br /> 16.lntervational Shipments ❑Mpodb U.S. El E0.4 from U.S. Pend eerylea : <br /> Transporter Signature ifor ea Date U.S.: <br /> w 16.Transporter AcluwMedgment of Receipt of Minerals <br /> T r1 Rintepl[yplKt7 SlonAre Month Day Year <br /> Z Transporler2PnMeMyped Nerve Sighheturo Menti Dry Year <br /> 17.Dwrepenry <br /> 17a Dwepancy Indication Space, ❑0"uty ❑Type ElPit". ❑verbal Rejedien ❑Fu,R*O. <br /> Marrlest Relerenre Number <br /> U.S.EPA ID NhmOer <br /> > 17b.Mental,Faddy(or Generate) <br /> 0. Fad iy's Phone: Month Day Year <br /> tic.SgnaMe d Altemene Feotity(or Generator) <br /> Ic <br /> O <br /> 18.Deaipheatl Fishily O,sere opener:Cerabwtlon ciwceyl of m Wi&covered by U*maMesl erupt as r6W in henh t7a <br /> 1 Pmde&Ty*Nam Sgnature Month Qay Year <br /> 169•BLC-05 11977(Rev.9/09) GENERATOR'S/SHIPPEO'S INITIAL COPY <br />