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NON-HAZARDOUS 1•Generator i0 Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Numtw <br /> WASTE MANIFEST N O T R E Q U I R E D t 886-4234= 4OD40-48.011 <br /> 5.Generalors Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 7-EMi11/f1 7-EbvefI.Skn NO. <br /> P.0,Box 711,DOMB TX 7=11 47 M Vind Dr.,SbC1111 n.CA SIMM <br /> Generator's Phone: i� <br /> 6.Transporter i ccan N e �' j 11.S,EPA ID Number <br /> I►j/ NUT REQUIRED <br /> 7.Transporter 2 Company N1. 8 U.S.EPA ED Number <br /> 8.Designated Facility Name and Sile Address U.S.EPA ID Number <br /> Yl1113els 001111 I C901Y;—P ftw Flirt Lem <br /> 3875 P411MO Fri L&M,Sulwn,CA 94595 N O T R E Q U i R E D <br /> Facility's Phone: } � � <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12,Unit <br /> No. Type Quantity tNt.Nol. <br /> t. <br /> GC <br /> Non Howdars'YIhIM.Sora(SON) 00i D T 10 Y <br /> rr <br /> W <br /> 2 � <br /> nr <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> Sor:99-900% Pyoft No: PLF-20-8915 <br /> Debift:0-1% <br /> Mw eppiropiftb WE when h@rrdfp or m regt*W I yto TWF ProoJodt No:40x60 <br /> 14.GEN ERATO R'SIOFFER OR'S C E RPRICATION:I hereby declare that the contents at this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations. <br /> Generator' Month b~0fMonth Da Year <br /> C I� <br /> r 15.international Shipments <br /> F 171 Import to U.S. Export from U.S. Port of err Iexit: <br /> a Transporter Signature(tor exports onl : Date leaving U.S._:_ <br /> cc 16.Transporter Acknowledgment of Receipt of Malkals <br /> W <br /> Transporter 1 PrintecVTyped Name 51gnature Mont Day Year <br /> R-00 <br /> N <br /> Q Transporter 2 PrtntedlTyped Name 619n tore Month Day ear <br /> 17.Discrepancy <br /> 17a.-Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Reled" ❑Full Rejection <br /> Manifest Reference Number, <br /> F 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> v <br /> Facitf y's Phone: <br /> ELI 17c.Signature of Alternate Facility(cc Generator) Month Day Year <br /> 4 <br /> t� <br /> rn <br /> W <br /> O <br /> 18.Designated Facility Owner or Operator:Ce ' ion receipt of materials covered by the manitest except as noted Aem 17a <br /> Printwryped Name S gnature Mo th Y <br /> 189-BLC-0 5 11977(Rev.9/091,11f, ❑ESIGNATEO FACILITY GENERATOR <br />