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j" Some \1 <br /> i <br /> r .0- <br /> NON-HAZARDOUS t.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.WasteTracking Number <br /> WASTE MANIFEST LW RECOMM 8854234= 214176 <br /> S.Csenetarara Nema and Maiyry Afton Generators Site Address(;dtlerent than n1aaang address) <br /> PWIP O CCROM CC1Pr C�3 No V50 <br /> 76 8 ..PA tlam ft CA x#18 „ ZM Tr=y 04 Trt*CA OM <br /> Gmardore Phone <br /> 6.Transporter 1 Coopry Name IAS.EPA ID Number <br /> • CARMI C <br /> 7.Trwipartea 2 Company Name IIS,EPA ID kd/aber <br /> S.Daighatted FacVAy Neme and SIM Address US.EPA ID Number <br /> KoMor COVIO Uml n, <br /> 981 B" RIS Nfd Reqtdped <br /> SPh mI <br /> 10-Codaainees 11.7c1a1 12,Unit <br /> 90. 9h U.5.DITT Daanlp rl(In wrig Rver shipping Name) OuanGty Ik114W. <br /> Nm. � <br /> 1. <br /> Ik�0� <br /> %%F=#m so U, OYJ P <br /> sezl 2. <br /> 0 <br /> 3. <br /> 4. <br /> 13,Special Handng InsruoWns arta Adctllontt lnformallan <br /> r <br /> Pn:e <br /> �• 24 hw=me.—%w42" i '2z" 42121010= <br /> M <br /> 14.GENERATORS CERTFXATM.I carldy bre matelots dneertnd above on This man'"aro rut subject to federal regulations for feporti N proper disposal of Hazardous V&sle. <br /> GwWratorea0 isrors Prirr6edflmd Name Signa ure Morm Day ydar <br /> AIS 61fd Gerawir-JChamm 4 <br /> -1 15.klermatlonil Shorn" <br /> F- ❑Import to US Export from U.S- Port of erdwal: <br /> 31 Tran oft S*gnai—(tor agues a*l: Def leaving U.S.: <br /> 16.10ansporbr Ackrwrlix"ent of Receipt of Maleriels <br /> Tt Prnledrfjpod Name a MOW Ikry *w <br /> 74M All <br /> i Transporter 2 PrnledRyped game Sgnm3re More Day Year <br /> 17.D�orepanry <br /> 17a Discrepancy Indication Space ❑Ouantmy ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> r <br /> Manifest Reference Ntrmber. <br /> r 17b.Alternate Facility(or Generator) U.S.EPA ID Nunber <br /> J <br /> V <br /> FaakA Phone: <br /> p 17c.Slgrlalura df Aftemali Fadiy(or Genaral0r) Month Day Peer <br /> w <br /> x <br /> 52 <br /> 18.aleaWaW Facity Corner or tor:Ca ffi anon of receipt of materials o74W by 9r1 menfesl except as noted in Ilam 17a <br /> Prin:!!:wd,Nam Signalure Month Qoy Year <br /> �S.`!C, <br /> 169-BLC-0 55 11977(Rev.9109) Ll TRANSPORTER#1 <br />