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e <br /> NON-RAZARDDUS i Generat0f 10 Number 2.Page 1 of 3.Emargeny Responso Phone A.Wale Tracking Number <br /> wAsrE MAIWFEST N!A 1 1877126048"5 17-16039-001 <br /> s Generatols Name and MaRng Address Generators Site Address(it different nan making address) <br /> Pacific Ethanol <br /> 3028 Navy Drive <br /> cerf8lARRftf CA 95208 �2eej1�15 <br /> 6 Transporter t Company Name U.S.EPA ID Number <br /> ..—FQadff Em irartm tial 17— <br /> Transporter 2 Company Name Lr S.EPA 10 Number <br /> 5,Designated FacSryr Name and Site Address U.S.EPA ID Number <br /> Potrero Hills Landfill <br /> 3875 Potrero Hills Ln <br /> Suisun City, CA 84585 <br /> Feciacr5_Phw: (107)4-32 <br /> ,400 <br /> r9.Waste Shipping Name and Des#tkn 10 Containers 11.Total 12.Unit <br /> t <br /> No. Type Oda" WuVol. <br /> Node-hazardous waste, liquid(rinse water) 001 i TT G <br /> ur <br /> L 2 <br /> d <br /> 13.Special Handling imttuctions and Addtiona€Intotmaton <br /> Pmfle PHLF-17-137 Truck#--LO_ <br /> Job#17-18039 <br /> 14,GENERATOR'SIOFFEAOR'S CERTIRCATION:I hereby declare that the contents of this consignment are WIty and accurately described abova by to proper shipping name and are dassl6ed,pacfaged <br /> marked raid labeledWaurded,aind aro in an respects in proper cw dbon for transport according to applicable mtam 1lonal and rational goverrvr enW regulations <br /> rotor sICM! is PtMtadFryped Nano ' <br /> Month Day Year <br /> All 17 STAAaA <br /> 15 blemabnall ShipmerAs ❑Import to U.S ❑Export from .S. Pert of entrylexit: <br /> Tran. +]Mer Siar'.aaee dGr exports oo i I. Da!e feavi'eu U'S <br /> ¢ 16 Transporter Ack vveledgmanl at Receipt of Materials <br /> Tnlruporter 1 PT#d mMonth Day <br /> �CxU � Signa �S i B I) <br /> 1 <br /> a Trdnsporta2Pdreets ypedName Signature MDnth Day Year <br /> 0 <br /> 17 Discrepancy �—t <br /> 17a.Discrepancy Indkation Space 11Osareay 1-1Typg ❑Residua ❑Partial Reieclieo ❑FUN RejecBon <br /> _ Manifest Reference Number <br /> 17b Altarnate Fadity'.or Generator) U.S EPA ID Number <br /> Fack yrs Phone <br /> d 17c Signature of Alternate R014;cr Generator) Mont) Day Year <br /> a <br /> W <br /> 19.Oesrgttaled Fadtiry ra3nr Gertt:rrauon of retaipt of materials coveted b1'ura manliest exrer,;as Holed it aero 1 a <br /> PrIniedfTyped Name Signature D <br /> 169-BLC-O S 11977(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />