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NON-HAZARDOUS I.Generator lig"unto 2.F2geld 3.Emergency Response Phone 4.Wastelfrocking Number I}(l <br /> WASTE MANIFEST '1UT .u=[,',)1bt :O 1 t:.Jv-!2'rCll.:;.! �,5[ <br /> S.GmemNMz Name and Ma'nkg Adkoss. Generators me Address In dillerent than mai4ng address) <br /> 16 tm 5. -.J, rn rt : A CA';L i33 2101 S'J ' .1G f Un,Umsz,:sl,G C-5Zj 1 <br /> Generators Rime <br /> 6.Tranywrier I Company Name <br /> U.S.EPA 1D Number <br /> 7.1na spoder 2 Company Name U.S.EPA ID Number <br /> 8.Desalepjaayh(Name eM Sl@ Andress U.S.EPA ID Nurtiear <br /> lli. 4..:dr e a 4 ..�1.I <br /> Fapllys Phone: p'.".ti'...,. s.'�5--SC'::1 <br /> Caddnea <br /> 9a. Bb,U.S.DOT Desaptbn(Imml6ng Proper shipping Name) Id. 11.Total 12.Um <br /> No. type Wenllly NgNd. <br /> afi <br /> a <br /> W 2. <br /> o ,! <br /> 3. <br /> 4. <br /> 13.Special Hw*V Inslruclbns and Aodlional InbrmalM <br /> 1�J� ^,tc^ ,..•.1 1,uw'�l . YtlrwG. . T 17d";`! �77'�,k aa:sna.uy� .;'sl <br /> rte:: 421210102"2 .., <br /> 711'u35-0.7 :. <br /> 14.GENERATORS CERNFICATION:I cem ly the maoalals desmlled drove m this manges)are not subject io babal reguNriorolo repodnl preper deposal of Hazardous Waste =d <br /> J Vtx- . idura �.. Month Day Near <br /> rj 15.Intanaliond shipments 'e <br /> r ❑krpat to U.S. Q Eryat from U.S. rDat denay/sora: <br /> � <br /> Transporter S' lure a s <br /> nsPoda 9N (a+r �Pnd nmy)' Date <br /> w 16.Traapaler AcImmledgemem d Recelpt of Materials <br /> Tlmsporlerl PM,eNfyped Name SignatuMonth Da/ Neer <br /> O f <br /> j <br /> Z Tangprler 2 PrknW ped Name Symatpre , :'✓ r Month Day hear <br /> 17.Discrepancy ` <br /> { <br /> 17a Disoeparcy Ndira6on Spam ❑Quantity ❑Tw. ❑flesidn. ❑Partial flajeclgn ❑Ful Rejection r <br /> i3 t <br /> Manifesl Reknenoo Number I <br /> 17b.Alternate FacMy(a Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL <br /> Do"Ph"'. <br /> 0 17c..Signature of Alternate Facilgy(a Gewnwer ) MOfdA <br /> w Day' Year <br /> Z <br /> O <br /> bG• <br /> VI .Designated FacMy Oemer or Operator:Certification d receipt of materials covered by the m ar&9 mem!as noted in Item 17a <br /> i tedTyped Nama Sigiv a ne Month Day tear r, <br /> 169-BLC-05 11977(Ree 9/09) t v' THANSPORTER#2 <br />