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I. <br /> d1r.a _ y <br /> NON-HAZARDOUS 1 Geporal¢r lD Numbw r - 2.Page td 3 Emergency Response Pipne. % fol 4.Waste Tracking Nombey ��„ � <br /> WASTE MANIFEST / Irrr 1�,`y.'ri'tfism .� LI 3 (✓'' r..z` .. <br /> 5.Gmsmtors Name and Ma/if/mg Atldess Gemratots Site Address in ddhtad than MTm9 addrem) <br /> ,7 <br /> /C” <br /> f <br /> + GwmmWfs Plane - - US EPA ID Number 111 <br /> i 6 TIrarspwtw t Comparry Name , y j - <br /> j 7.Transy¢der Z Company Name i - - - U.S.EPA ID Number <br /> U.S.EPA ID Number �+ <br /> 6 De_grebd FadiN Nance and Site Address <br /> //�>it rY/z / ;zRr jr- y, ♦' .1/u'i >��yrwt.{ra!:S.tJ <br /> FadPll <br /> 16.Containers 11.Total 12.Unit <br /> 9.Wage Skipping Name and Descnplmn Ng Type Ouadity WI7Yd. <br /> a [ f(� N1 2�Y1L H <br /> ou Y <br /> w <br /> w - <br /> i <br /> 3. - <br /> 1! I <br /> jj a. <br /> IEi <br /> 13 Special Nandhng Instructions And Additional Idomal:on r - // r pf t <br /> '..^n.L /j1.r l�ts /!+/ .•yc.Tf rzF.:+1 f.. rc�+�t2: to ?,sr�st.!(H'9 � f v'} 1 �.�` .(/ f <br /> 1 L7rj`.'d+Gbi c r �,> 7✓t.,P�i $it4�' -r `�/s'dr+r?y+�-/' - t ,., <br /> . ,'rl H r �.ss.•.,K,<,.te y' Yi t�tl,�:-r- �,�5"'�3cw� ;�;"7-frrfw'�ai'� - �'+st/f."% -"� �/�'1�i r�- - <br /> { 14.GENERATOIPS/OFFEROR'S CERTIFICATION:I hereby dedzre lbw are indents of thisc¢ilslgrown are My and aawa:ely=9;9 <br /> escrDed�:bl'Ihe proper sNpph+g name.and ora classified.packaged <br /> marked and labeleNpknrded.and are in all respells in Oraper OmNlimfapar�al acogrding t¢allinkabb mtemational and mRogw' ectal bguhdons. <br /> Gmemb7Y06erw's PnnbQRypetl Name 9gaWm / .1 Mmrel "Ir Year <br /> fit l s e'..- !Tr ��:�'� rA .;re:•Y.af/I'J (!. -(�'I#eirtrrr"r .'///,T <br /> 15.Memawal ShVmehls E]import to U.S: ❑Export Imm U.S. Pod Of emryledl: <br /> Tansponer Signature for oTorlls and Date bort U.S.: <br /> o; 16.Transporter Aci maledgment of Receipt of MandaE <br /> TrerspwlwlPmltedlyyped Name <br /> W 5rgnalure- / �. - MorM any Yeer <br /> T lT .. J ..._.rf�F j/ <br /> m - !' l - <br /> z Tdgl <br /> rDfler2PmledRypeO Name ,f - Sigrelub� t j MoMt Day Yew <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Ouarnity ❑Type Rwanda ❑Partial Reled'mn ❑FUR Rejection <br /> f Madlew Reference Number: <br /> > 17b.Alternate Fad Ry(w Generwor) - _ .U.S.EPA ID Number <br /> CJ <br /> 3 tai Fadlilys Ptlme: - � <br /> p W 1%.Signature of Altemele Focolty(or Concmlor) - ' - Mmtlh Dry Year <br /> z f <br /> W <br /> < p <br /> 16.Desgnaled Fa Iy Owner w Operet_or:Ce 11 <br /> itrcalmn of'rJefc{alp d mabnw eov/mall by Pro manilesl ercepl as Wed in Clem f7aM07 0�,a/y <br /> I <br /> PrmbMypad Name (, .k. 1' / /j, f 1.1 �Y \ 1lure e'^-- �..,�---' /�,. /J <br /> �9 ..: f <br /> 169-BLC-05 11977.(Reu.9/09) U - � TRANSPORTER#2 <br />