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1 <br />�IOP(HA7r4RDQ.US 1• Generator ID Number <br />2. Page 1 of 3. �me+gency Response Piwne 4. Waste Tracking Ntm�ber <br />WASTE MAN(FFST: ' NOT APPLICABLE 176889 C (9 <br />5 Gene s f5a andl0• Ing 1 tl O <br />( 'I Generators She Address at di terent than mating address) <br />GenAr4hcA <br />8. Transport r 1 <br />- U.S. EPA ID Number <br />T arts o r ompany Na NOT AFPrt.ICABLE ' <br />U.S. EPA ID Number <br />8. Designated Facility Name and Site Address IOT APPUCAELE <br />RECOLOGY HAY.ROAD U.S. EPA ID Nwar <br />6426 FLAY ROAD - VACAVILLE, CA 95607 NOT APPLICABLE <br />Fadi aPhone: 0 67&4718 <br />9. Waste Shipping Name and Description 10. Conte11. Total 12. Unit <br />:No., Type Quantity WtNOL <br />RPR a; <br />'s i <br />x 41 e^ <br />13. Spada! Handling iris AddlHonal Information £r•` <br />�4 <br />M <br />14. GENERATOR'SIOFFEAOR'S CERTIFICATION: Ihersby dedam that the contents of this consignment are fully, and accurately described above the <br />marked and labeled/placardedand are in aA respects in proper conii>tion for transport according to eppiiceWa international and national governor ental regId0�ore Aping name, and are classified, packaged <br />GbneratoeatOfferors Printed/Typed Name Signature <br />v OGS + Year <br />15.Inte Shipments <br />0 import to U.S. ❑ Export from U.S. Port of entry/exit: <br />Tra erSI nature for ex its ont Date leavl U.S.: <br />18. Transporter Ackn*edgment of Receipt of ateri�ls <br />Transporter 1 Printed/Typed Name 1 ! t <br />9 1 a z. li /I) � 1 A / i, f . 7n !4 � � t Slg n re /1!t qq Year <br />r a,.. ! - !ih r ., .. Month �DH`�f. ..1 <br />17. Discrepancy <br />17a. Discrepancy Irxticdtion Space <br />❑ Ouentityy ❑ Type E Residue El Partial Re <br />Jecybn ❑Full Rejection <br />M. Alternate Facility (or Generalor) Manifest Reference Number. <br />U.S. EPA ID Number <br />Facilltyrs Phone: <br />17C Signature of AHemate Facility (or Generator) <br />Month Dail Y <br />18. Designated Facility Owner or Operator. CertiHcalion of recel�t.of.meterials covered by 1he.manifRd except noted in Hem Iia <br />ELP, /Typed ame Si ture —� <br />M th ' Year <br />t <br />3LS-C 5 TtM.(Rev. 9/09} rt — • <br />TRANSPORTER #1 <br />