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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 I N O T R E Q U I R E D 1 808-4234XW 400413.48447 <br /> S.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 7-E*ftn 7-ENK lE SkM No.X0632 <br /> P.O.Box 711,DfeNn TX 7=1 4627 Do Vhd Dr..Sbekbn,CA 95M <br /> Genorator's Phone: MM)82 <br /> 6.Transporter 1 CiRvany ' U'S.EPA ID Number <br /> NOT REQUIRED <br /> 7.Transporter 2 kyf4amG U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Vftsb Conneciom-Potrero{ b L.ancM <br /> 3675 Popro Hft Lana,Suisun.CA 94585 NOT REQUIRED <br /> Facifi 's Phone: <br /> (111M 949.9451 <br /> 9.Waste Shipping Name and Description t0.Can[amers ti.Total 12.Unit <br /> Ni. Type Quantity Wt1V01, <br /> 7. <br /> a Non Hazardous Wa16,Soil(Soli) 001 D T 10 Y <br /> W <br /> a 2. <br /> W <br /> t� <br /> 3. <br /> 4- <br /> 13-Special Handling Instructions and Additional Information <br /> SO:99-1w% Prolfe No: PMF-20 -M <br /> DOW 0-1% <br /> 'Wafer appn)priNs WE when hancOM or n ragfArred by to TSDF Pto)W No:40sM <br /> 14.GENERATOR'S16FFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classilied,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for Iransport according to applicable intematfoml and national governmental regulations. <br /> Generatorsf & W& fon b~0(GV*18W AM" <br /> MCS "(&OWL&14"aaww) 4fo-n oaf <br /> 15.Intemationa4 Shipments <br /> fr ❑import to U.S. ❑Export from U.S. Port of entrylexil: <br /> x Tran ort%Signature for exports only): Date leaving U.S.: <br /> w 16,Transporter Acknowledgment of Receipt of Materials <br /> Tran sp or 1 PrintedlTyped Nam Sianatur� Mg D y �ea�r' <br /> y IPJ f7' tU <br /> Transporter Printsaypod Name Signature Month Day Year <br /> cc <br /> i- <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quankty ❑Type El Residue ❑Partial Rejeciion ❑Full Rejection <br /> Manifest Reference Number: <br /> 17b.ARemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> c� <br /> LU <br /> W <br /> IZAp <br /> 16.Designated Facility Darner or Operator:C 'tication t of materials oonered by the manifest except as noted in Item 17a <br /> Printed/Typed Name Signature Mont <br /> I r V,ji LNs�-, I <br /> 169-BLC-0 5 11977(Rev.9/09) DESIGNATED FACILI TO GENERATOR <br />