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NON HAZARDOUS Al.WaideTraCking Number <br /> WASTE MANIFEST <br /> t. <br /> S.Generators Nm ame ameeting Address 2 312 <br /> GallefutorS Site Address(if diffowl me,ft"address) <br /> Gelleardiff's Phone <br /> 6Jitinsperter I Coug,"Name <br /> U.S.EM 10 Number <br /> 7.Transiourter 2 romparry Name US EPA 0) <br /> NwMar <br /> B.Dersprated Fa*j Name and Sale Aftess; <br /> U.S.EPA ID Nmpr <br /> FacritTS Phone; <br /> Name) <br /> Its. 9b.U.S.DOT D"oripfim(malurling Proper Stippiatif IO.GD Inem 11.Total 12.UIR <br /> I Na Itpe Quantity WtAtj. <br /> 0 t <br /> w <br /> or 2. <br /> 0 <br /> 3. <br /> 4. <br /> 13.Special Hanciong Immuclons and Additional Inlormallon <br /> rT <br /> It.GENERATOR'S CERMCATION:I MW the materiels clescrillasol ObM an this manifest am nor subject to federal re"flons for reporting proper disposal at Hazardous Waste, <br /> Gsmersto,`O.�W.frimWrWNaTe I Signature 4 <br /> 7i Del 'e" <br /> -j15,Inlemational Shownis <br /> F- 11 Import to U.S. ElExpowt hour U.S. Port of entlyraxt <br /> lansporter Signature(Jor exports only): Date leaving U.&: <br /> QC 16.Transpoilet Ackwoledgermarl of Fruceipt of Materials <br /> to <br /> Transporter I NntedrTyped Name <br /> S"tuffe/l/ A�ndii Day Y. <br /> 4 z Transparter 2 PWed%W Name Signature Month Day Year <br /> 17.Dscepancy n. <br /> 17a Discrepancy ladbalion Space Eloux" 0 Type 0 Residue ❑pardid R*dw El Full Rejectiar <br /> Monflest Bermance Number. <br /> M Allemale Pwility.ar Cammmr) U.S.EPA ID Number <br /> FaeWs Phone: <br /> 17c Signa um of Alleriale Facft for GerwasilM Mouth Day <br /> Ir <br /> z <br /> 18.Designated Fadlity Oicaer or Operalor.Cntficalion of iedelie at materials Maul by the warifird coastal as noted In Item 17a <br /> Partedrrypeol Name Slgnatu <br /> re y Dry <br /> year <br /> 169-BLC-0 5 11977(Rev.9/09) TRANSPORTER.N2, <br />