Laserfiche WebLink
-32 <br /> NONHAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response PhoneWaste Tracking Number - <br /> WASTE MANIFEST NOT APPUCA&E 7— 53821 <br /> K.—Ge rator'sName and Mailing Address Generator's Site Address(if different than marling address) ,, l <br /> '2431 6• 14A'(+p45G l�ra�. <br /> . sin cA 9s2 <br /> 15 <br /> GeneraloesPhone. — q S xl�roh <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> r iInc . NOT APPLICABLE <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> NOT APPUC:ABLE <br /> B.Designated Facility Name and Sills Address U.S.EPA ID Number <br /> RECOLOGY HAY ROADb N01 r1PPUCARLE <br /> 4`6 NAY RO�IJ VACRVti_LE, CA k-��I E L <br /> tl <br /> Fact'; s Phone: !.707). 67"71A <br /> Shipping Description MAR 0 3 2015 10.Contalners 11.Total 12.Unit <br /> 9.Waste 5 ' Name and hon d <br /> No. Type Quantity Wt vol. <br /> Cirol � IJCnIr(1*�r'D�QT��1,Awf <br /> W IW j <br /> Z 2. <br /> W <br /> (S <br /> 3. <br /> 4. <br /> i <br /> 13.Special Handling Instructions and Adc%onal Infomrafion ` <br /> i <br /> 14.GENERATOR'S/OFFEROR'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 labeled/placarded,and are in all respects in propercondAlon for transport according to applicable International and national governmental regulations. <br /> Generator's/Offerors Prirrtedrryped Name Signature `^ /. Month Day Year <br /> .J 15.International is <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylerit <br /> Transporter Signature gore ds only): Date leaving U.S. <br /> W 16.Transporter Acknowledgment of Receipt of Materials <br /> Transpolar 1 Printed/typed Name Signature <br /> ccMonth Day Year <br /> OIL 1 S — <br /> ¢Q Transporter 2 Printedfryped Name SVwfure Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type El Residue ❑Partial Rejection El Full Rejection <br /> t <br /> fdaMesl Reference Number: <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> W <br /> O <br /> 18.Designated Facility Owner or Operator.Certification of receipt of mat4dift covered by the manifest except as noted in Item 17a <br /> PdnteW/ryped Name Signature Month y Year <br /> 16"LS-C 5 11979(Rev.9109) DESIGNATED FACILITY'S COPY ' <br /> i <br />