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NONHAZARDOUS I. Generator ID Number 2. Page I of3PnnraMtneQqt <br />onse Phone 4, Waste Tracking Number <br />WASTE MANIFEST NOT APPLICABLE 1 176886 <br />S. /Qverat a N and MSI g Address l /�rt(ress (if different than mll! acid" s) <br />P p <br />Generators <br />8. Transport i Comp erne 1 U.S. EPA ID Number <br />r NOT APPLICABLE <br />7. Transporter 2 qompany Name <br />U.S. EPA ID Number <br />NOT APPLICABLE <br />8. DasignatedFacIlly AmWand Site Address U.S. EPA ID Number <br />RECOLOGY MAY ROAD NOT APPLICABLE <br />6426 NAY ROAD. -f! VACAVILLE, CA 95587 <br />Pariah/'. Phn ^hn7l A -FP 471!R f <br />Ig. <br />Waste Shipping Name and Description 10. Contehers 11. Total 12. Unit <br />Ilff <br />No, Type Quantity mivol.. <br />`q `;• <br />1. <br />a <br />ion azar v 4r6at wo D o <br />� •� .. <br />t t <br />il. f c <br />f <br />4. <br />ZtM+y5�� y wb��} r ri�'•.j��N a�TkY'! <br />13. Special Handling Instructions and Additional Information <br />14. GENERATOR'SIOFFE3OR'S CERTIFICATION: I hereby declare that the contents of this consigrvnent are July and accurately described above by the proper shipping name, and are classified, packaged, <br />madcedand labeled/placarded, and are in all respects in proper condition fog transport acoording to applicable international and natlonal.governme tal regula <br />I <br />GeneraloealOfferoP Prinled/T ed ame Signature Month pay Year <br />, , a , <br />15. InternaIp nls <br />Import to U.S. ❑ Export from U.S. Part of entry/exit: <br />Transporter Signature for exports only): Date leaving U.S.: TM' <br />cc <br />LU <br />16. Transporter Advgwl*menl of Receipt of Materials <br />2 <br />CL Cn0M <br />Transporter 1 Prin <br />yped Name <br />ll <br />Signature s M Da <br />a` j 6 <br />0A I <br />Trangporter 2P nt ype Name Sig azure Month Day Year <br />ccF <br />17. Discrepancy <br />17a. Discrepancy Indfcalion Space El Ouen6ty ❑ Type ❑ Residue ❑ Partial Rejection ❑ Ful Rejection <br />Manifest Reference Number. <br />17b. Alternate Facility (or Generator) y; U.S. EPA ID Number <br />v <br />ua <br />F c fity's Phone: <br />17c. Signature o(Alternate Fedrdy (or Generator) Month Day Year <br />a <br />z <br />H <br />�c <br />�'jsy''PSk. �'iwrr:4 'LrL1�i kS' G�ytia. ..C1���. ..`Y' ` {.YeH 3a i9f, ,,�p�t�,.e"y.. r ar i,.Y":t� aY R".; '• vrY �ti �c i <br />7 $1 k+ep,F'f A• �i t t �'S. G ..;�i.�sh'iR` 4 a' .se ii ,.h tt .&.3c �-t,. <br />r ' ,yi��yiy� }�$4 ��. y F��' .� ����sfk:�` �:' • Ti-�e�,Sl��s'T,, F„r:��� `J�i��cit4S�.-S �� 7 �1��,tit4 T����.r, <br />,.. f <br />• ',.R& rS-'j.� ��Sy.yx5 <br />�Y. rr �y} �;N ��: - �� '� "�': � 3`�'?' 1�d <br />Y�';: �: k�li: ,i �x� d1 J;cY,• F `'� t$t )y,,(.. <br />9 <br />'..'M,JewrSa 'n ..e 13 �„ .S � ro_ �� "���:._. � 4�. �il. T u „i'.aYo1��'�`Y "'�'2NR`t�.-....�.'5�� <br />18, Designated Facility Owner or Operator. Certification of receipt of materiels covered by itis manifest except as noted In Ile 7a <br />Pyped Name P Month Day Yea <br />E j9Llr '—zc;1 !G <br />169 -BLS -C 5 11979 (Rev. 9/09) TRANSPORTER #1 <br />