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NON•HAZARaOUS I Gensratnr tD Number 2 Page 1 of 3.Emergency Response Plane 4.Waef Taoelr�p h V <br /> WASTE MANIFEST N/A 1 1877 256-BW5 "17 <br /> 5.Genecifi Nemo and Maung Address <br /> Pacific Ethanol Geremtors Srte Address jif different ftn ma N address) <br /> 3028 Navy Drive <br /> Slog! , CA 95209 <br /> Generate s <br /> 6.Transporter 1 Company Name - <br /> U.S.EPA IQ Number <br /> PonderEnvirRmrneldalServicesinc I CAR0001t30737 <br /> i T ansparfer2 Company Namo I U.S FPA 10 Number .. <br /> 8.Deslgnaled Faotity Name and Site Address <br /> Potrero Hills Landfill US EPA ID Number <br /> 3875 Potrero Hills Ln <br /> Suisun Cly,CAA945M <br /> Facia 's Prwfe: (7 22-4022CAR000089488 <br /> 13.Waste Srdppiog Name and Destwliatlon 10.Containers 11 Total 12 unit� <br /> No� Typeantiry WINd <br /> Norrhazal'dous waste, liquid(rinse water) 001 TT C, + <br /> W <br /> 2 . � <br /> a � I <br /> i 13.Speclal Har3dlir3g Insttlutkms and Addidarlal lnfonnal6an — <br /> PraNe PHLF-17-137 Truck#� <br /> ,Job*'17--18039 <br /> 14.GENERATOR SIOFFEROR'S CERTIFICATION;f hereby declare that the cements of IN3 consomenl are fatly and 9=rataly described eWve by the proper shipping Warne and are classified packaged, <br /> ma*ed and fatxeledlpiacerded,and are In al respects in proper torld lion for transprxt accord;ng to applicable I T rnatianat and natbnai govemmenW mgLMons. <br /> /G�'ONerorer�yped Meme Sign urnew ., Month Day Year <br /> -1 15,International Shipments I yR � <br /> ❑tmpon to U 5. ❑E)gort S Port of eNrytem <br /> Y Tra tarter S..natunl;for e.,;.urlu TqI, Date laflviiq U 5. <br /> m 16,Transporter Acknowtdgment of Receipt of Materials <br /> Transponer 113' L% "- Signal Month Day Year <br /> f raruparter 2 P edffyped Name <br /> 5 gnat — 17 <br /> Month Day Yeas <br /> 17 Discrepancy _ <br /> l7a Discmpaney Indication Space {�r I-� -f��°11❑ l Gaanaty L I Type ❑Rasfdue �I J PartaF Rejection ❑Pto Rej ej, <br /> Manilesf Refene re <br /> 17b Alternate Feta ity;or Generasor) Number U.5 EPA 10 Number -- <br /> C'1 <br /> 16 Fecftyls Plnne <br /> 17c i6i of M-a%Faddy for Gmenettsrj _ <br /> Month Day Year <br /> Q <br /> 18.Designated Frmilily Owner or oPerwr million of MOW of Matedafs covered by the mandest except as rued h!tern 17a <br /> PrintedlTyped Name - S§nature <br /> 489-13LC-05 11977 SRev.9109} -- <br /> DESIGNATED FACILITY TO GENERATOR <br />