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NON-HAZARDOUS 1.Generator ID Num1w 2 Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number�pp((��- <br /> WASTE MANIFEST NOT APPLICABLE _L S 3 O 0 2 <br /> 5.Generator's Name and Mailing AddressGenerator's Site Address(if different than mailing address) <br /> Ow <br /> Generator's Phone: ?'fit ! l ?q 3 e-o 7 ,, <br /> 6.Transporter 1 Company Name � �l / <br /> U.S.EPA ID Number <br /> NOT APPLICABLE <br /> 7.Transporler 2 Company Name ' U.S.FPA ID Number <br /> j <br /> NOT APPLICABLE <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECOLOGY HAY ROAD NOT A^Pt.ICABLF <br /> 13428 HAY ROAD-VACAVILLE, CA 96W7 <br /> FaciliflesPhone: 1707116784716 <br /> 10.Containers 11.Total 12-Unit <br /> 9.Warta Shipping Name and Description <br /> No. Type Quantity WtNol. <br /> 1. r <br /> W <br /> Z 2. <br /> W <br /> C7 <br /> 3. <br /> MAR 13 2015 <br /> 4. - r- .� ►fin �r.��-1 <br /> - i <br /> 13.Special Handling Instructions and Additional Information <br /> # /39OG 7 � <br /> 14.GENERATOR'SlOFFEROR'S CERTIFICATION:I hereby declare that the contents of[his consignment are lully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlp'.a carded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generator'slOfteror's Printe�yped Name Signature j Month Day Year <br /> 15.International Shipments <br /> ❑Import to U.S. ❑Elwlt from U.S. of enlryrexit <br /> Transporter Signature for exports only): Date leavin U.S.: <br /> 16.Transporter Acknowledgment of Receipt of Materials <br /> cc Transporter 1 Printed(Typed Name Signature Month Day Year <br /> N <br /> ':Lfir_ , �,� - �,,.J r' i <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> I <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> } 17b.Allernale Facility(or Generator) U.S.EPA ID Number <br /> j <br /> r.1 <br /> rai Facility's Phone: <br /> W 17c.Signature of Alternate Facility(or Generator) Monlh Day Year <br /> C <br /> 2 <br /> 0 <br /> W <br /> O <br /> 18.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest Except as noted in Item 17a <br /> Printed(Typed Name / Signature f, , if _ Month Day Ye Tr <br /> 169-BLS-C 5 11979(Rev.9109) DESIGNATED FACILITY'S COPY i <br />