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NON44AZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST NOT REQUIRED i 88942343 4O 40.48.024 <br /> 5,Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> 7-EMAN 7-EWM Sb1t No.8201M <br /> R.A-Box 711,Dema TX 75221 4627 On Vk%d DF..SbCk n,CA 95207 <br /> Generator's Phone: ffM 828496M <br /> n.Transp o any N U.S.EPA ID Number <br /> NOT REQUIRED <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> Mob COWNCOOM—P01111ii Hlb LaR Ml1 <br /> 3675 P 11111Wo��epF�#�kt LOW,atif�gl'1.CA 94695 N O T REQUIRED <br /> Facie s Phone: (9m 949-9451 <br /> 8.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit <br /> No, Type Quantity wt./Vol. <br /> 1. <br /> AC <br /> Non HU1111 daue Yl fe,Soil MGM) 001 D T 14 Y <br /> tr <br /> v, <br /> 2. <br /> 3. <br /> 4, <br /> 13.Special Handling irMructons and Additional Information <br /> SM.,99-1w% PMM No: P11LF;-20-M <br /> Debft'O-1% <br /> mar appiDPltign PPE 1A hen 11armlhg or m regtied by#*TWF Project No:am <br /> 14.G ENERATOR'S/OFFERO R'S CERTIFICATION:t hersby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and lahetedfplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br /> Genarator'sfOlferoes PrintedlT ped Flame Signature Mond D y I y,�ar, <br /> Patrick IMoGowM oe behaf<of Gerrl iMiw gat�ltckl�IoGor L{d L;E�+satwr�] 'rJ/, z <br /> a 15.lntemational Shipments <br /> ❑Impart to U.S. ❑Export from U.S. Port of entrylexit: <br /> — <br /> Transporter Signature for exports only): Date leaving U.S.: <br /> cc W 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrimedlTyped Nam Signature Mon p Year <br /> ° �• <br /> N <br /> z Transporter 2 PrimeOyped Name Signature Month Day Year <br /> d <br /> cc y <br /> � I <br /> 17.Discrepancy <br /> 17a.Discrepancy Indicalkan Space ❑ wy El L1Residue 11 Perlia]Rejection ❑Full Rejection Gluon' <br /> Manifest Referanee Number: <br /> 17b.Affemate Facility(or Generator) U.S.EPA ID Number <br /> 1 <br /> u <br /> u Facilily's Phone; <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> d <br /> z <br /> N <br /> i1J <br /> A <br /> 18.Designated Facility Owner or Operator,Certification of rece of materials covered by the manifest except as noted' It 17a <br /> Printed+Typed Name Signature on <br /> 169-BLC-0 5 11977(Flexr.9109) DESIGNATED FACILITY G GENERATOR <br />