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NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste tracking Number <br /> WASTE MANIFEST N Q T REQUIRED 1 888.4234H)O0 4OD40-48.006 <br /> 5,Generators Name and Mailing Address Generator's Site Address(it different than mailing address) <br /> 7-EUM T-ENAM SSM NO. <br /> P.O.Bax 711,Deft% Tx 7'=1 4627 Do WWI Dr..stern,CA S&M <br /> Generators Phone: ")f2"!= <br /> 6.Trans�1�jzl <br /> U.S.EPA ID Numher <br /> NOT REQUIRED <br /> 7.TransporAf 2tornpany Nade U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Mob Cvrrrecftm-PCOM Flt l andM <br /> 3676 Mao 1Ift LAM,Ste,CA 94586 N Q T REQUIRED <br /> Facility's Phone: w5)949.9461 <br /> 9.Waste Shipping Name and Description 10.Containers 11,Total 12,Unit <br /> No, Type Quantity Wt./VDI. <br /> i. <br /> Non IiMURNS V165Y,%W(Sol)i 4 O I D T I- <br /> W <br /> z 2. <br /> W <br /> L.7 <br /> 3. <br /> 4. <br /> 13,Special Handling Instructions and Additional Information <br /> ftt 99-1w% F"M NR: PHL.F-204W5 <br /> Weer■ppraprink PPE whm hncmg ft or Is nmp*ed by#e TSM Project No:40M <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name.and are classiried,packaged, <br /> marked and labeledlplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Generators! err r ped Na 0n WWFof t n t � � Mwl1t Day Year <br /> j 15.International Shipments <br /> Import to U.S. El Export from U.S. Port of enhyfe* <br /> Transporter Signature for exports only): Date leaving U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of Materials <br /> W <br /> J—0 <br /> a Tran rter 1 Print yped Nam r. Signatu /r Day Year <br /> IL <br /> W <br /> 4 Printaffiryped N@& ure Month Day Year <br /> t- <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Cwantity ❑Type ❑Residue ❑Portia!Re)ection ❑Fult Rejection <br /> Manifest Reference Number. <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> La. Facility's Phone: <br /> G 17c.Signature of Altemate Facility(or Generator) Month Day Year <br /> x <br /> S2 <br /> N <br /> W <br /> r3 <br /> 18.Designated Facility Owner or Operator:Certificatleg,of regopt of materials covered by the manifest except as noted in Itei 17a <br /> Printed?yped Name Signature th <br /> 169-BLC-0 5 11977(Rev.slag) DESIGNATED FACILITY O G RATOR <br />