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NON-HAZARDOUS 1.Generator ID Number 2,Pagel of 3.Emergency Response Phone r 4.Wasta Tracking Number <br /> WASTE MANIFEST p,((;}'�')'{�;,(,� ISD Eltlt.t•A`IQ- <br /> •� 6.Generators Name and Melling Address <br /> Generators bus Address QI diurnem than mailing address) <br /> ! �trap X41 F'rladus��x IJ 4 iRll4)OfMA tF�Atin:tlelrek Iceman eoatiinx RarwhMan"n Rand <br /> t38 114'orpn %CxIm,Indif4rlepoll IN x1WO Tracy,CA 037? <br /> Generators Phone: i•• U.S.EPA ID Number <br /> 6.transporter l Company Name CAMlLl IA833B <br /> Are><a'bnn Integt'aW Selvk*k Ina. <br /> x' <br /> 7.TransporterU.S.EPA ID Numberer 2 Company Name - <br /> 6.Des!noted Facill Name and Ile Address US.EPA ID Number <br /> %-1 .raan)<pn al4d1� <br /> 901 HaBeyRoad NntRaqu>Rad <br /> Facili 's Phone: MbUra,CA 04585 <br /> 10.Contahrpre 11.Tolel 12.Unit <br /> 9.Waste Shipping Name and Description <br /> No. Type Quantity WlNol. <br /> w1. <br /> a NGR-HazzidousUWd o Sold(£,.DH) CJs GM y <br /> W <br /> w 2. <br /> 3. <br /> 4 <br /> 13.Special Handling lnskuctions and Additional Information 17�tftili: 102,337 SAPM248 j <br /> y.�.�� 114Y3 Milit: 7QGW4 CitAAI W223 + <br /> V{k ar pratvdl�e BALI 1mRNlvrhYe llendFrKi. Weiglataorvok.Imeb Pr~ 4212107711A <br /> afrrapproxhahe, 24horemervoK7nunAwr(OW)424• BW Pro)edft: 74102.842 <br /> chemu". a <br /> 14.GENERATOR'SfOFFEROR'S CERTIFICATION;I hereby declare that the contents of the consignment are fully an amgfatelydescribed above by Ore proper shipping name,and are classified,packaged, <br /> marked and IabeledrplacaNed,and are In all respects In proper condition for transport affording to applicable Inlemaliof(al and national govemmenlal regulations. <br /> Generatoesl0flerors Pdnledrryped Name SI nature ff Month Day Year <br /> AIS on beha41 Of$OPUS-J bitcraw" 4/� `.• <br /> 15.International Shipments <br /> ❑Import to U.S. ❑Expod from U.S. Pad of aMry/exiC <br /> Turns oder Sl nature for exports only): Dale leavin U.S.: <br /> m 16.Tmnspoder A�rtnovdedgmenl of Receipt of Matetlals r <br /> Transporter��nledlt'yped Name _ <br /> Signawre x Month Day year <br /> o h!/� .1 I�I <br /> C- !P' Myt 0 ly':�9 I'i+•> Month Day Year <br /> z Trenspoder2Pdntad/ryped Name Signawre <br /> r <br /> A 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejectkn <br /> Manifest Reference Number: <br /> r 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> u4. Facililys Phone: <br /> w 17C.Signature of Alternate Facility(or Generator) Month Day Yea <br /> z <br /> W <br /> N <br /> W <br /> O <br /> 16.Designated Facility Omer or Operator.CeNfkation of receipt of materials covered by the manifest except as noted in Item 178 . <br /> Prinledxyped Name Signature Month Day You <br /> 799-BLC-05 11977(Rev.9109) GENERATOR'S/SHIPPER'S INITIAL COPY'::, <br />