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I: <br /> NON-HAZARDOUS 1.GeoeraAx ID Nun6er 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number f <br /> wasrE MANIFEST NOT APPLICABLE . 3818 <br /> I <br /> 5.Generator's Name and Maung Address Generators Site Address(d different than mailing address) <br /> (a` T>raAsA10 '�P A ?�'3j �j,_ osA <br /> V` �rC� <br /> Generafors 2 - a R <br /> 6.Transporter 1 Company Name !� U.S.EPA fl)Number <br /> r, a 1c.t L r C. N -f AFPLICABL.E <br /> 7.Transporter 2 Company Name 1 1 U.S.EPA ID Nutter <br /> NOT APPI-ICABLE <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number ! <br /> RECOLOGY HAY LOAD - NOT.;F-PLIC ABLE <br /> 13426 HAY ROAD - VACAViLLE,CA�'5 <br /> Fad s Phone: (' F _ .471 A - <br /> 10.Containers11.Total 12.Unit <br /> 9.Waste Shipping Name and Description MAR 0 .12015 <br /> No. Type Quantity WL/Vol. <br /> ENVIRONMENTAL <br /> i <br /> Z 2. _.. . <br /> 3. <br /> I <br /> 4. i <br /> 13.Special Handling Instrucions and Additional Information <br /> �3 s0/d <br /> 14.GENERATOR'S10FFEROR'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 labele4lacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generator slOfferor s Prvded/ryped Name Signature Month Day Year <br /> .,. <br /> 15.Intemafiona(,Shipments <br /> ❑Import to U.S. ❑Export from U.S. rt of entry/exit <br /> Transporter Signature(for exports on ): Date leavin U.S.: <br /> cc16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature / J) Month Day Year <br /> Transporter 2 Printed/Typed Name Signalure Month Dey Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Inclication Space <br /> ❑Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection <br /> I <br /> Manifest Reference Number <br /> T 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> � J <br /> lu <br /> j a Facility s Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> H <br /> z <br /> 2 <br /> N <br /> Lu <br /> 0 <br /> i <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a ` <br /> PrinledfTyped Name i i Signature Monlh Day Year <br /> 169-BLS-C 5 11979(Rev.9109) '~ -� DESIGNATED FACILffY'S COPY <br />