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NON•HAZARDOt1S 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT REQUIRED 1 868-#'t''.�KW 4I10�¢4l1.OZi <br /> 5.Generator's Name and Mailing Address Generalor's Site Address(if different than mailing address) <br /> 7-EWM 7-EWM Sion No.82101M <br /> P-Od BOX 7111,DRIM TX 79221 4627 Do And Or.,Sbekkm .CA 96207 <br /> Generators Phone: PM 828-6590 <br /> 6.Transporter 1 Cop y4krlp/ :M4LJ� <br /> U.S.EPA ID Number <br /> NOT REQUIRED <br /> 7.Transporter 2 Corngany Name i U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA 1D Number <br /> 3675 Po>M0 Fie larre,SUhM,CA 945+95 NOT REQUIRED <br /> W5)949»9451 <br /> Facili 's Phone: <br /> 9.Waste Shipping Name and Description 10•Containers 11.Total 12.Unit <br /> No, Type Quanhty MJV01. <br /> 1. <br /> rr <br /> a Non Hazard m Mie,SSW(''.,011 001 D T 10 Y <br /> w <br /> z 2 <br /> w . <br /> 3. <br /> 4, <br /> 13.Special Handling Instructions and Additional information <br /> so:99-7110'16 Pro1M W. PKY 2045 <br /> Dtebft 0-1% <br /> vllaer apprapdob PPE whm twxW g or w regWmd by the TSW Pry No:411280 <br /> 14.GENERATOR'SIOFFEBOR'S CERTIFICATION;I hereby declare that the contents of this consignment art,Fully and accurately described above by the proper shipping name,and are classified,packaged. <br /> marked and labeledlplacarded,and are in all respects in proper condi4on for transport according to applicable international and national governmental regulations, r <br /> Ganerators)Offeroes Pkrnted=0nba11a�01'G n Fur ��� � � Mond Year <br /> l11 1z) <br /> 15.Enterra[coal Shipments ❑Import to U.S. ❑Export from U.S. Por!of entry/exit: <br /> ? <br /> Transporter Signature for exports 0 'Date leaving U.S.: <br /> m 16.Transporter Acknowledgment of Receipt of Materials <br /> ¢ Transporter 1 Printed7yped Name Signature Ll <br /> ear <br /> O ti <br /> a <br /> 0 <br /> Q Transporter 2 Printed)Typed Name Signature Month Day Year <br /> 2- <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Futl Re action <br /> El4uantity E]Type ❑Residue EJ Partial Repection j <br /> Manifest Reference Number: <br /> 17b Alternate Facility(or Generator) U.5.EPA 1D Number <br /> J <br /> U <br /> u Facility's Phone: <br /> LL, 17c.&gnalure of Alternate Facility(or Generator) Month Day Year <br /> r <br /> a <br /> x <br /> cs <br /> w <br /> a <br /> 18.Designated Facility Owner or Operator:Certification of recak4materials covered by the manifest except as noted in rn 17a <br /> PdntedlTyped Name Signature onI y <br /> 169-BLC-0 5 11977(Rev.9169) DESIGNATED FACILITY10 GENERATOR <br />