Laserfiche WebLink
NON-HAZARDOUS '.Generator f0 Number 2.Page t of3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT REQUIRED i 8$8-423.8060 4004D-415-010 <br /> 5.Generators Name and Mailing Address Generator's Site Address{if different than mailing address) <br /> 7-ENiAM 7-Eki Sblr Na.82063 <br /> P.O.BOX 711,Deb* TX 75221 46V Dr Vhd Dr.,SbCkbk CA 96M <br /> Generators Phone (972) <br /> 6.Transporter 1 y a e ; US-EPA ID Number <br /> NOT REQUIRED <br /> 7.Transporter 2 Company Name U.S.EPA IA Number <br /> 8-Designated Facility Name and Site Address U-S.EFA ID Number <br /> VAwft CionnoIb n–Pokill H&LVVIM <br /> 31M 11M LVID.Su(suM CA 94566 NOT REQUIRED <br /> Facility's Phone, om 940-9481 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit <br /> No- Type Quantity Wt,Nol. <br /> 1. <br /> cc <br /> R NM"Nawams ms YVA is,Soil!(SON) 001 0 T 10 Y <br /> cc <br /> U, <br /> z 2. <br /> w <br /> la <br /> 3_ <br /> 4, <br /> 13.Special Handling Inwructfans and Additional Information <br /> sot 99-100% PMft No: PMF-2046 <br /> Dobft 0–1% <br /> Vkbw appm9ft r:PPE M41ffi11 11mxft or■1B rrlgl hm!by 111@ MOP Project Na: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 classified,packaged, <br /> marked and iabeiedlplacarded,and are in all respects in proper oandilion for transport a000rdmg to applicable international and national governmental regulations. <br /> Generatorsr err ri ped Nor � l n{u Day Year <br /> Month <br /> 14 <br /> 15.International Shipments ❑Import to U-S- ❑Export ham U.S. Port of entry/exit: <br /> z Transporter Signature for exports only): Dale leaving U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of Matedafs <br /> LU <br /> Transporter 1 PrinvWryped Name Signature MV 1) Year <br /> s- �> <br /> E Transporter Printed)Typed Name Signature Month lay Year <br /> N <br /> 17,Discrepancy <br /> 17a,Discrepancy Indication Space ❑ ty yp E J I L1Fi;fl Rejection quinti. ❑T e ❑Residue I— Partial Rejection <br /> Manitest Reference Number: <br /> r 17b-Alternate Facility(or Generator) U-S.EPA ID Number <br /> J <br /> 0 <br /> u Facllity's Phone: <br /> Lu 17c.Signature of Alternate Facility tar Generator) Month Day Year <br /> 4 <br /> 2 <br /> L7 <br /> N <br /> w <br /> 0 <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials cave red by the manifest except as n24d In Item 17a <br /> Priraedff yped Name sign re th y �7 Y r <br /> 159-BLC-0 5 11 Re .9 9) DESIGNATED FACILITY TO GENERATOR <br />