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NON-HAZARDOUS 1,Generator ID Humber T2. a 1 of 3.Emergency Response Phone 4LWaste Tracking Number <br /> WASTE MANIFEST NOTREQUIRED 1 6 <br /> 5.Generator's Name and Mailing Address Genaralor's Site Address(it diff srent than mailing address) <br /> 7-EI V@n 7-EI/4W No.*20= <br /> P_d.BOX 7111,004M TX 75M 4627 Da VInd Dr.,SbCkkxt,CA 955207 <br /> Generator's Phonaj. ffm 41284M <br /> fi-Transportersmi'l— <br /> � U.S.EPA ID Number <br /> NOT REQUIRED <br /> 7-Transporter 2 Mamea-j Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> VARds r.+ nrIOCOM-POW*Hlk Lan0 <br /> 3876 PCOM Hlb LaM,SUblill CA 94195 N O T R E Q U I R E D <br /> Facili 's Phone: M5)9416m11 <br /> 9.Waste Shipping Name and Description Ia.Containers 11,TOW 12,Unit <br /> No. Type Quanlity Wt.Nnl. <br /> 1. <br /> ° Nan H@=FdKW wast,SON(sa) 001 D T i s Y <br /> a <br /> ff <br /> 2- <br /> 3. <br /> 4. <br /> 13,Special Handling Inshuctions and Additional Information <br /> Sol:99-10D% Pr'ft No. PHLF"204M <br /> DOft O-1% <br /> 1Msar approprImb PPE when hmv*m or as mquked by ft TSDF Praod Na:40M <br /> 14,G E N ERATOR'SIOFFE ROR'S CERTIFICATION:f hereby declare that the contents of this consignment are fully and accuralely described above by the proper shipping name,and are classified.packaged. <br /> marked and IaWodld placarded.and are in all respects in proper oondition for transport according to applicable international and national governmental regulations. <br /> Generatarsr err Pri ped Na On wt�� w � tng�u g „ �� r�� � MIA Da Year <br /> 15.International Shipments �'f�+ i <br /> ❑Impartto U.S. ❑Export from U-5. Port of eniryiexih <br /> Transporter Signature for exports only): Date leaving U.S.: <br /> m tfi.Transporter kknowledgment of Receipt of Materials <br /> TPrintedfrypeOvidName Signatu <br /> M <br /> dd— <br /> N Y ar <br /> Z Transporter 2 PrintecITyped Name Signature Month Day Year <br /> cc <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity 1:1 Type Ll Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> r 17b.Alternate Faciiffy(or Generator) U.S.EPA ID Number <br /> C7 <br /> tui Facility's Phone' <br /> Ca 17c.Signature of A[temate Fackily(or Generalor) Month Day Year <br /> d <br /> x <br /> t7 <br /> w <br /> m <br /> n <br /> 18-Designated Facility Ow r orQperat . rtification of if of materials covered by 1he manifest except as noted in Ito 17a <br /> PrintedlTyped Name \112 Signature o a <br /> 169-15LC•0 5 111977{Re 8109} DESIGNATED FACILIT TO GENERATOR <br />