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NONHAZARDOUS 1-6010ratw 10 Number 2.Pa—ge7 of 3.Emergency Respons Prone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT REQUIRED i 888.423-6080 40040.48-OD4 <br /> 5,Generators Name and Mailing Address Generators Site Address lit different than mailing address) <br /> 74EMfMMt 7-EWftn Sion No. <br /> PA.8M 711.Deft TX 76M 4627 Do Moet Dr-SbcAbn.CA 9=7 <br /> Generators Phone: (M) <br /> 6.7ransporter anyqiar2I&�4; <br /> U.S.EPA ID Number <br /> NOT REQUIRED <br /> 7.Transporter 2 Company l7me U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Mob CO wwft fi-P14"M Hit LWKM <br /> BTS P MM HIS LW*,SUK t,CA 944 NOT REQUIRED <br /> Facfli s Phone: (925) 1 <br /> R.Waste Shipping Name and Description 10.Cor>tainers 11.TOW 12.Unit <br /> No- Type Quantity Wt,/Vol. <br /> f. <br /> Non He�aroloilslA NW SON(SON) 001 D T 10 Y <br /> rr <br /> z 2 <br /> W . <br /> r� <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Informafion <br /> SOW 99-10091 F"ft NO: PF U-204M <br /> Dabdr.0-1% <br /> lA w apploppiiMt PPE when handling or w m quked by ft TSDF PFoled No:40260 <br /> 14.GEN ERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately dwribed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport wording to applicahle international and nalional governmental regulations. <br /> GeneratarsJ ars ri t ped N e�I)ON ofGtllllOW n u �`�SCOMcMV) Month Day Year <br /> l5.International 5hipmerltsIm rt to U.5- <br /> ❑ pe ❑Export from U.S. Port of entrylexif: <br /> Transporter Si nature for exports onl : Date leaving U-S <br /> m16-Transporter Acknowledgment of Receipt of Materials <br /> Trans e t 'nt y Nam Signature Month Day Year <br /> n l -�-- <br /> a Transporter 2 Printedriyped N# Signature Moath Day Year <br /> a <br /> F <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number' <br /> 17b.Alternate Facility(or Generator; U-S.EPA ID Number <br /> U <br /> ua Facility's Phone: <br /> C1 i 7c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> 2 <br /> t3 <br /> IN <br /> W <br /> p <br /> 18.Designated facility Owner or Operator:Certifkatian of receipt of a als covered by the manifest except as noted in Item 17a <br /> Printed7yped Name Signature o Ye <br /> 169-f3LC-O 5 11977(Rev.9109) DESIGNATED FACILITY 0 GENERATOR <br />