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NaN HA2ARQat1S t•r;ensrator ID Number i 2.Page 1 of 3.Emergency Response Phone rwaste Tracking Number <br /> WASTE MANIFEST NOT REQUIRED 1 3 4OD4D-48-020 <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 7-EIw0111 7-ENPM SbM No. <br /> P.O.009 711.Deflels TX 75221 4627 Ds VMd Dr..Shw*bft.CA 95207 <br /> Generators Phone: Pel 8254690 <br /> 6.Transport mpa N U.S.EPA lD Number <br /> ' NOT REQUIRED <br /> 7.Transpo er 2 Company Name I I U.S.EPA 10 Number <br /> S.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 3676 Pair M HES LHM,Sul W,CA 914680 NOT REQUIRED <br /> Facility's Phone? (11M I <br /> 9.Waste Shipping Name and Descdplion 10.Containers 11.TOW 12.Unit <br /> No. Type Quantity Wtivol. <br /> 1, <br /> ff <br /> a Nan Hs KdM Waft,%N(WI)i 001 D T 10 <br /> z 2. <br /> w <br /> 0 <br /> 3. <br /> 4- <br /> 13.Special Handling InshucMns and Additional Information <br /> I sot 99-lam Proft Na: PH0140466 <br /> Vftw app impibb PPE w m hwKft or w F&qL& d byto TSW PM*d Na:40= <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:l hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name.and are ctassilied,packaged. <br /> marked and labelediplaca€ded,and are in all respects in proper condition for transport according to applicable iMemational and national governmental regulations. <br /> Generators) er r' Pri t ed Na � i n Eu Cd�scg�3 Month Day Yr , <br /> -1 15.international Shipments <br /> Import to U.S. Export from U.S. Port of entrylexit <br /> Trans arter Si nalure for exports only): Dale leaving U.S.: <br /> cc 16.Transporler Acknowledgment of Receipt of Matedals <br /> LU <br /> Transporter 1 Printed/Typed Name Signature r Month Da Year <br /> ° —TVrt 1 M �- <br /> a <br /> N <br /> 4 Transporter 2 Printeffyped Name Signature Month bay Year <br /> fL <br /> 17.Discrepancy <br /> 178.Discrepancy Indicalion Space <br /> ❑Quantity ❑Type ❑Residue ❑Par6a!Rejection L1 Full Rejection <br /> Manifest Reference Number. <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> a <br /> U <br /> Facility's Phone: <br /> w 17c.Signature o!Alternate Facility(or Generator) Month Day Year <br /> a <br /> a <br /> tp <br /> 'm <br /> ut <br /> n <br /> 18.Designated Facility Owner or Operator:Cerlifica ipt of materials covered by the manifesl except as ted in Ite <br /> PrintedlTyped Name Signalur nth ay <br /> 189-BLC-05 11977(Rev.9109) DESIGNATED FACILITY Ta G N ATGR <br />