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F u I <br /> NON-HA7ARIDOUS 1"Generator ID Number2.Page 1 ai 3.Emergency Response Phone 4.Waste Tracking Number 0702434 <br /> (ti 43 4 <br /> WASTE MANIFEST NQ"1'REQ1j D 1 88" (/ <br /> S.Generators Name and Marling Address Generators Site Address(it different than ma®Eng address) <br /> ROlp 86 ConvaW <br /> ear CDP�No i7W <br /> ivB &+�IAW818 =75Trwy BW,PWA CAW= <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> S Designated Facility Name and Site Address U.S.EPA ID Number <br /> Kahl Ca rAm Lauff ! <br /> Wl B dle*y Raid Not Rft*lhld <br /> FaciM es Phone: <br />' 10.Containers 11.Total 12.Unit <br /> 9.Waste Shipping Name and Description <br /> No. Type Quantity WI.NoI. <br /> O . <br /> a NM+%nF$M&Wage <br /> age PM X114 -45,vP <br /> z <br /> W 2. <br /> 3. <br /> 4. <br /> 13.Special Handrmg Instructions and Additional Information <br /> Wow prdec&a egdpllral wllffe hwWbg- Weigh or vduwas we <br /> appiuMn 24 hour may mundw(M)4MAW Ptairadd:'-4212101 <br /> 14.GENERATOR'=FFEROR'S CERTIFICATION:I hereby deflate that the coniesnts of Pis wWVnmW are ruly am aecoratey described ab7m by the proper;6IppngAftnt,kid are cbssfW,paC>r Pd, <br /> marked and labeiedrplecarded,and are In aA respeds In proper cond nn for transport accordng to apploablai7lemalidul end national Qavemnenlat regUtaiinns. <br /> Genaraeofs'Olremes PrhlcdiTypod Mame SiFetwa ,Ir <br /> ji 15.I dmsa1 wal Shipments ❑frrort to U.S. ❑Expo,imm U.S. Pon d er"relk <br /> liraftsparterS nature foe exports on : DoteleavinU.S.: <br /> m 16.Transporter Admowledgment of Receipt of Materials <br /> uj <br /> rz <br /> Year <br /> 0. T% Aka edRAL1,�r w 6�y*NameSia 4 2-Month y9 3 <br /> a Transputer 2 Printedliyped Name Signature Month Day Year <br /> dC <br /> f- <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantity ❑Type ❑Partici!R ❑Full Rejection <br /> yp ❑Residua eJeclion <br /> Manifest Reference Number. <br /> 17b.Mlemate FaCllity(or Generator) U.S.EPA ID Number <br /> J <br /> U _ <br /> roc Facility's Phone: ` <br /> F17G Signature of Allern me Facility(or GaneralO r Month Day Year <br /> C9 <br /> 4 <br /> 18,Desirased Fadktly Owner or Operator:Ce n d recut of materials covered by the marglait except as mted In Ilam 17a <br /> PrintedfypedName Sfgnawre Monti Day Year <br /> -OYIA r <br /> 169-BLC-0 6 11977(Rev.9109) TRANSPORTER#1 <br />