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NONHAZARDOUS 1.Generator D Number 2 Page t o1.3Emergency Aespensc Flwna 4.Wasto Tmckhg Number <br /> WASTE MANIFEST NIA 1 (877)25&13255 17-16039-003 <br /> 5 Ganeralors Name and MaFN Address Generators Ste Address(1 differerl than magng addrM) <br /> Pacific Ethanol <br /> 3028 Navy Drive <br /> St an,CA 152D8 t -a0 <br /> Generata 5 <br /> _ <br /> 6.Transportar 1 Company Name <br /> U.S,EPA ID Number <br /> Ponder Environmental Services Ino CARDOOIS0737 <br /> 7 T ansporlar 2 Cmpaq Name --- <br /> U.S.EPA ID Number <br /> a.Designated Facility Name and Sfte Address — i- U.S.EPA ID Number <br /> Potrero Hills Landfill <br /> 3676 Potrero Hills Ln <br /> Suisun City. CA 945136 <br /> Feel,e Phoria f7 OD 4 32-4 022.- CAR DOO D894 6 8 <br /> 9.Waste Shipping Name and Description tU.CanaEnacs 11 Total 12 Uril <br /> Na. Type Owntty Wt1W <br /> C <br /> aNark-Hazardous waste, liquid(rinse water) 001 TT 77CJ0 G <br /> W <br /> Z 2 <br /> W <br /> (7 <br /> 3 r <br /> 13.Spedaf Fiarxilirp tnstruolione and At€ditbnai lnfannation <br /> ProNe PHLF-17-137 Truck 0 <br /> i .lob#17-18039 <br /> 14.GENF-RATOR'SIflFFEROKS CERTIFICATION:I hereby declare drat the contents of ois consignment are fully and accurately described above by the proper atrfpphg name and are clas.0ed packaged, <br /> marked and W*ed*carded,and are in all respects in prDper comir6on for transport e=rding to app 1cable latema0vW and national m emmantal regulaflona. <br /> Gene-toes(©fteror's Pr"a ffyPed Name 51 store <br /> � 64) g Month 13 Year <br /> ,0ik 117 <br /> T5.Inlem27onel Sldpments <br /> ❑Import to U S ❑Esport I Port 0 entry:aril. <br /> Trar.�•_ter S mature fa exN-11 ON,:_ Date leavtx U S.. <br /> 16.Transporter AdutowkKigment of Receipt of Materials <br /> - <br /> TrarVcrtar I PTIZTyped Name e Signature Maps Day Year <br /> CL <br /> TrarLsparfer 2 PrigledrFyped Nems 51gna3ure17 <br /> Mardh Day Year <br /> 17.Discrepancy {t <br /> 17a.Discrepancy Indication Space ❑r3uanl ty ❑ <br /> Two ©Residue ❑Partial Refection ❑Full r1e(acllon <br /> _._ _ <br /> Mantles!Refers Humber <br /> } t 7b Ansmata Facility(or Ganeralar) �� U.S.EPA 0 Number <br /> a <br /> t3 <br /> L FaCillty's Phone- <br /> ii; SvaWre of Attemate Fadity(or Generaror) — trlardh Day Year <br /> Z <br /> in <br /> W <br /> v <br /> !a.Designated Fadl4 Owner or Operator Cefirrr:atl n 101 malarfals ocwred by the manliest euept as ncta-d In It 17 <br /> Pre�tedRyped Name Sig tatu2t- j- <br /> 169-BLC-0 <br /> 5 11977(Rev.9109) DESIGNATED FACILITY TO GENERATOR <br />