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r <br /> NON-HAZARDOUS 1.Gen)e,ator m Number 2.Page 1 of 3.Emergency Response one 4.Waste Tracking Number <br /> WASTE MANIFEST NOT APPLICABLE 8 Q rj <br /> 5.Generator's Name and Naifmg Address Generators Sb Address(1 ddterenl than rtaiblg address) <br /> r,►4 <br /> Generates Phone: / L'^✓/�°�' `' %� <br /> 6.Transporter 1 Company Name / — j U.S.MPA ID Nurrber <br /> NOT APPLICABLE <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> NOT APPLICABLE <br /> B.Designated Facility Name and Site Address U.S.EPA D Number <br /> RECGLOGY HAY ROAD NOT APPLICABLE <br /> -+26 HAY ROAD -VACAIALLE, CA 95W <br /> Facility's Phone: (707)6784718 <br /> .Containers 11.Total 12 Unit <br /> 9.Waste Shipping Name and Description IN <br /> NO. <br /> Type Quanf➢ty wwa. <br /> ul 2" <br /> (7 <br /> ,1 - <br /> I <br /> 3. W 0 3 2015 I <br /> 4. <br /> 13.Special Handling Instrrclions and Additional Information <br /> /v <br /> 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I herebydeclare that the contents of this coni meet are full and accurate described above b the proper shipping name,and are classified,packaged, <br /> 9th Y N Y P oP PD n9 <br /> marked and labeled/placarded,and are in al respects in proper condition for transport according to applicable intemational and national govemh <br /> menl regulations. <br /> Generator'sfOfferoes Prinled/Typed Name Signature �. ; Month Day Year <br /> J 15.International Shipments 1 <br /> ' ❑Import b U.S. ❑Export from U.S. Port of entry/exit <br /> TransIporter Signature Por exports on!y): Date leaving U.S.: <br /> ¢ 16.Transporter Acknowledgment of Receipt of Materials /t <br /> Transporter 1 Print edrrad Name Signature / J //�� Month Day Year <br /> z Transporter 2 P 1'w Name Signa ure _ Month Day Year <br /> i <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space El Full <br /> El than'iry El Type F]Residue Partial Rejection Rejection <br /> I <br /> Manifest Reference Number. <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facililys Phone: <br /> 17c.Signature of Aftemate Facility(or Generator) Month Day Year <br /> 4 <br /> 2 <br /> W <br /> O <br /> I <br /> I <br /> 18.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest eKcepl as noted in Item 17a <br /> Printed/Typed Nam? Signature f r' Moth Dai Year <br /> DESIGNATED FACILITY'S COPY <br /> 169-BLS-C 5 11979(Rev.9/09) <br /> I <br />