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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 NOT REQUIRED 1 886-423 MM 4OD40-48.009 <br /> 5.Generator's Name and Making Address Generator's Site Address(if different than mailing address) <br /> 7-Ebvm 7-EWM SIO No.8201M <br /> PA.001 711,DaBu TX 75221 4627 Do Vinci Dr.,Skx:b n.CA 95M <br /> Generator's Phone: <br /> El-Transporter1 C mp m ] � � _ + U.S.EPA{p Number <br /> NOT REQUIRED <br /> 7,Transporter 2 Company Name U-S.EPA ID Number <br /> 8-Designated Facility Name and Site Address t1-S.EPA ID Number <br /> Wofk eta-Pdrafo Wi LwmIIIIII <br /> 3676 PloftM Hft lam,Ste,CA 94M NOT REQUIRED <br /> Facia' 's Phone: (925)966-M1 <br /> 9,Waste Shipping Name and Description i D.Containers 11.Total 12.Unit <br /> No, Type Quantity Wt./Vol. <br /> 1- <br /> fL <br /> a Non Huwd ns VIS.Sold 0011 I3 T 10 Y <br /> W <br /> s 2- <br /> W <br /> C7 <br /> 3. <br /> 4- <br /> 13.Special Handling Inouctions and Additional Information <br /> 80:99'10D% Prole No: PHLF204M <br /> DabdK Q-1% <br /> Ww appropiftle PPE when Iiffilli"or n regtiad byft IBM Prood No:40M <br /> 14,GE NERATDR'S10FFEROFFS CERTIFiCATiON:I hereby declare mat the contents of this cansignmerd are fully and accurately dew hed above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeleftfacarded,and are in all respects in proper condition for transport according to applicable international and nalwal govemmentai regulations. <br /> Generaiorsl���It, �� .S�>MQ�DIq� I���� Mant a Year <br /> 15.international ShipmenlsEl <br /> Import to U.S. ❑Export from U.S. Port of antrviaxit: <br /> Transporter Si nature foT exports only): Date leaving U.S.: <br /> cru 16-Transporter Acknowledgment of Receipt of Materials <br /> Tansoorer 1 Prim 1T a e r} SignatureM�th Year <br /> N L - -� _ <br /> a Transporter 2 PrinfecVTyped Name Signature Month Day ear <br /> w <br /> 17.Discrepancy <br /> i7a.Discrepancy Indication Space ❑ ❑Full Ra ecfion Quantity ❑Typ9 ❑Residue Ll Rejection 1 <br /> Manifest Reference Number. <br /> 17b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> S <br /> U <br /> Facility's Phone: <br /> 17c.Signature of Altemate Facility(or Generator) Month Day Year <br /> a <br /> x <br /> s3 <br /> in <br /> W <br /> r5 <br /> 18.Designated Facility Owner o perator.Certification of receipt of materials covered by the manifest except as not in lta t7a <br /> PrfntelCfyped Name Signatur th y e <br /> 169-SLC-0 5 11977K,,.9/09) DESIGNATED FACILITY TO GENERATOR <br />