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08/02/2018 10:3' <br />(FAX) P, 051/065 <br />NON•HAZAmou8 1 G"rator tD Number <br />WASTE bfANl1'EST S5 (�S a=sP6{'r: <br />2. Page t of <br />'J'', EfnerOM Ruponee Phare 1', Waste Tra(kMq Number <br />�0� . r_ r- f <br />NamemidMaung Address <br />b e Site A u (1 owomm <br />mef g address) <br />'LfL1C1pany <br />E57�� <br />Name <br />U-5 EPA O Number <br />7. Tnmsponer 2 Companyr Name <br />AU.S. <br />EPA ID Number <br />B, besigrrated Facility Name and Sita Address <br />o ��'rOLC' 7 `; �': :: r�pJ `� <br />U-5- EPA ID Number <br />F Phone• f707) <br />B, Waste 9hlpping Name and DeacripUon <br />10. Con"'' ro <br />11. Totef 12. Ural <br />1. <br />No. Typo <br />pue try wtfNof. <br />iwtt:�( C)v i rrc �, <br />IVaC, <br />�i[31 /'j <br />YVnr!► /r`r <br />�[ <br />r� <br />S <br />4, <br />13. ice! Idartdilnq Inain,dione end Addalonel Inlormatlon J. <br />NT <br />14.Ot Nt3gATOR S/OFPeROR'9 CER71FtCATIpf/; Thereby declare Thal �e coraerda of this meet d k <br />marked and hsbe OFFERows, end en M all ON-Ireap" H cot»ign aro f* an axwatety deeeribed above by the proper shipping name, end ere claadlNd, pada gad, <br />proper oondltbn br transport a000rinq b eppllcal>!e trNurutbnel aril natbnal gwammenral nqufeUona. <br />0 erawfiloBer¢ s Printatlri7 Name 61 naquer Month Day Year <br />15, Inemetlonal Shipmanis rf--�� I I I; <br />i J Import to U.S. LJ Export from U.S. Port of erllry/od: <br />LwoWWr Si tura for agn only):Date le U,S.: t <br />t6. Trar®porter Acknowledgment of Receipt of Malsrlels <br />Transporter 1 Printed/Typed Name ff 9igrreture Month Day Year <br />TmrmwrW Y PdrrdedYTyped Noma 31 Month Dey Yur <br />1�. Dhxreper>cq <br />❑ Ruarrdry ❑ Type ❑ Residue D PaRlat Refection ❑ Full Rejection <br />Manifest Refenrnn. AAimFwr <br />U.B, EPA tD Numbor <br />7c, Signature of Atlernab Faulty (or <br />L Deaignaled Faouay owner or Operator: CerdAoeUon of receipt of mafadsts covered by the manifest except u now in Itjrtt vif <br />taod+T�ped Name f <br />LO -05 11979 (Rev. 9109) <br />Year <br />TRANSPORTER41 <br />