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NON-HATAHDOUS 1.Generator ID Numbor 2.Page I of S.Emergency Response Phone d,Waste Tracklog Number <br /> WASTE MANIFEST 1 9004244M N H 5 ® 0 2 8 6 N <br /> 6.Gan tots N mad Maalllaa Adtlres5 Gaaeialor'a Site Address Of differant than meting address) <br /> MP <br /> 3919 E.French COMP ROQd <br /> Meth CA 95.336 <br /> Genamtofa Phons: 2M M-24" <br /> B.Transporter 1 Company Namo U.S.EPA ID Numbor <br /> IE rwhonmental loglMlt,Inc. CARD D D 2 1 7 5 1 3 <br /> 7,Tmnspodar2 Company Namo U.S.EPA to Numbef <br /> B.Deslmeted Fap�li <br /> tNlJem4end SVaAddross U.S,EPA ID Numbar <br /> 3675 Poftio HMS Lane <br /> Suisun CA 94695 <br /> Faclll ',Phono: 707 X32-4622 C A R 0 ® 0 0 8 g 4 6 6 <br /> 10. <br /> Con here 11.Tool 12.UNt <br /> g.Waal;Shipping Nam and Desorption <br /> No. Typo Duantlly wwm. <br /> o ; <br /> No N�ute Sold(Dried Sweeps Shtdpe) <br /> s o y <br /> 2 <br /> 4. <br /> 19.Spac r�n Irawctlona and Additional Infomwrmn VV1095002M <br /> 94.OENERATOR'ayOFFEROR'S CERTIFICATION:I hemby declare[hat the contents of INN consignment era fully And amnately described adore by the proper Rhlpping name,and are coeaifiad packaged, <br /> marked and Inboledrplacardad,and are In as respects In proper condition for banalow According to applicable Imomntlondl and nallonal goverrmomel rogufallons. <br /> IofalOflorofs ledyry tl Name 5 Mo Day Year <br /> l �V <br /> 15.Icaam lanal Shipments ❑Impo .S. ❑Export 7,4a Pon of nmry/114! <br /> Tams onot Slonatum(for exports artyl' Data leaving U.S.: <br /> 1$.Transporter Admoviladgmerd of RaCElpl Of Materhh <br /> T r1,Ptlmadlfype emola4 �` S � �M� �aay ` a� <br /> Tmnsponer2 PdnladRyped Namo 1 velure ( �' Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Incpaullon Space ❑Comity n Typo ❑Residue ❑Panhl Rejacllon I_I Full Ralaction <br /> Manlimt Ralwarco Numbor. <br /> 17b.Alternate Focally(or Gancralor) U.S.EPA ID Number <br /> U <br /> rar- PACIIIt s Phone: <br /> iv 17c.Slgnalum of Altamato Facitay(or Generator) Month Day Yosr <br /> N <br /> 1s.Daslgnatod FacRlry Owner or operator.CaMlkallon of racalpl of malmlela covered by the mbnllosn oxcept as notod In Item 17a <br /> PrinWnWW Name Slgnaturo Month Goy Year <br />