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I <br /> _ _ I <br /> NON-HAZARDOUS 1.Genarabr 10 Nw" 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT APPLICABLE 163822 <br /> 5.Generator's Name and Mating Address GeneraWS Site Address(if dttlerent than matting address) <br /> 1A2A <br /> Generator'sPhllne: Q — 3410 f0 <br /> 6.Transporter 1 Compmy Nmne U.S.FPA ID Nwber <br /> NOT,'TPI sCAUE <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> NOT Afar-; 7CABLE <br /> 8.Designated Facility Name and Sde Address U.S.EPA m Number <br /> RECOLOGY HAY ROAD NOT APPUCABLE <br /> 931-426 HAY ROAD-VACP.V UE, CA 9WK <br /> Facr1' s Phone: 67fL47113 <br /> 1D.Containers 11.Total 12 Unit <br /> 9.Waste Shipping Name and Description <br /> No. Type Quarmy Wt/Nol. <br /> W <br /> w 2. w — <br /> MO <br /> r4.3. <br /> 13.Spe Handling Instructions and Additional Infonnatlon - <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged. <br /> marked and labeledrplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> ! Generators/Offerers Printed/Typed Name Signature Month Day Year <br /> 15.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. , Port of enlrylexit <br /> Transporter Signature for exports only): Date leaving U.S: <br /> r 1&Transpoder Acknowledgment of Rece pt of Materials <br /> Transporter 1 ed/Typed Namet/ZZ <br /> Signatuf r MoNh oay 7 Year <br /> t Al <br /> IL <br /> i Transporter 2 PrintedRyped Name Signature Month Day Year <br /> i <br /> 17.Discrepancy <br /> 17a.Discrepancy Ind cation Space upon ❑Full Reocion <br /> ❑Quantity ❑T)'pe ❑Residue ❑Partial Re" 1 <br /> Manifest Reference Number. <br /> F 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J I <br /> U <br /> LL Facifilys Phone: <br /> .I W 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Lu <br /> I Lu <br /> tl <br /> FP, <br /> Dnated Faclity Owner or Operator.Certification of receipt of materials covered by the manttest except as noted in Ilem 17a <br /> edTypedName —� / Signature �. %ir Month Day Year <br /> 16"LS-C 5 11979(Rev.9109) DESIGNATE FACILITY'S kOPY <br />