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NONHAZARDOUS 1,Genereta 10 rA2nbor 2 Page 1 0l S.Emergency Respone2 Plane 4,Waste Treating Number <br /> '9 <br /> WASTE MANIFEST ' N H 5 0 0 2 6 6111 <br /> s.Can mrts N�manmPiasp Oenemlafs Srto Addmes(If dlHerenl than reefing address) <br /> 3919 E.Froneh Camp Road <br /> Manteca CA 96336 <br /> Genetatars Phone: 209 SN-2W <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> Environmental Logldkx, Inc. C A R 0 0 0 2 1 7 5 1 3 <br /> 7,Transponar 2 Company Name U.S EPA 10 Number <br /> B.Dasluuomd FflG�idNem and SIIAAdtlress U.S.EPA ID Number <br /> 3676 Potrero HBs Lem <br /> Suftn CA 94565 <br /> Feclll 's Phono: 709 432-4W A R 0 0 0 0 8 9 4 B 6 <br /> 9.Waam Shipping Name and Deacralon 10.Conialnem11,Total 12.UMf <br /> No. Type Quantity Nivol. <br /> 1. NoMiezardoua V1he1e Sold(Dried Swinge 3hrdps0 <br /> y <br /> 67 2, <br /> _ .a <br /> d. <br /> 13.So%MWnictlons and AddlUmal Information <br /> 94.GENERATDR•SIOFFEROR'S CERTIFICATION:I hereby declare That mo comante of W5 consignment am fully and eccumrely da erlbed aeave by iho pmpor shipping name,and are daeaglad,packaged, <br /> marked and Iabeladlplararded,and are In of rospoots In propor condition for transport according to appll6eN2 international and nati nail gwernmemal rogulallons, <br /> roeelciftarar me ad Name SI Month Day Yesr <br /> / /� <br /> cam. 15,into ono Shipmenfa Imply .S. ❑Ekpon tom U.S. Pon of enirylesit: <br /> z <br /> Trans poner Slan(�wm bra r Dale leaving U.S.: <br /> ac 16.7mnepoiterAoknowledgment of Receipt of Maianaki <br /> 0Tra r1,Pdntedllype am8 SI Month Day YaA <br /> LAVI <br /> Transponor2 Pdnted(ryped Name Tgnaturc Month Day Year <br /> 17.Dlacrepaney <br /> 17a.Dilotepancy indication Space <br /> ❑Ouandfy ❑Type ❑R0912Uo ❑Panlal Raleoilon ❑F48 Raiadlon <br /> Manlie9l'Reference Number; <br /> P 176.Agemate Faidily(m GaneletbrJ U.S.EPA ID Number <br /> u <br /> W Faclutys Phone: <br /> 17c.Signnturn of Allomnm Facially(or Generator) Month DAY Veer <br /> 18.Designated Fadrty Owner or Operator.Codification of recoipl of melenals covered by the manifest except an noted In He;172 <br /> PrintedRyped Name Slgnalum Month Day Yea, <br />