Laserfiche WebLink
M N -0 — cn <br /> O = I jV O <br /> FT 00c: <br /> � <br /> N Q• 0NO <br /> -Tl En <br /> 4k C <br /> O O'.,h W Q <br /> CD —17 <br /> O X <br /> n � <br /> • • • a <br /> Pubashad M J.J.KELL IATES.INC!.Neenah�Wl. .(900)127-6968•likelierccm•Pnntotl rn the United Slates <br /> -17 <br /> 0 <br /> 0 <br /> 2.Page 1 of 3.EmergencyResponse Phone 4.Waste Tracking Number 178907 <br /> ^O 0 <br /> NONHAZARDOUS 1 Generator ID Number 8 l9 O � <br /> WASTE MANIFEST NOT APPLICABLE / 9/6) E3"1770 -- 0 o_ <br /> '�J UB� �� LL Generator's Site Address(d dferent than mailing address) -00 <br /> �I .ST N _ <br /> i Generate".-Name aril Mailing Address G/.j s�Ti�& �B/1jA4114-Vjy" 3 <br /> s:��•-rte, joy <br /> Generator's Phone�7pG�G�Sz•=?is_=�'��� lf�f%�fl/�YJi!_�OCOUM� __. <br /> �— U.S.EPA ID Number fn <br /> 6,Transporter 1 Company Name <br /> NOT APPLICABLE <br /> U.S.EPA ID Number <br /> T Transposer 2 Company Name <br /> NOT APPLICABLE 0 <br /> B+Designated Fatally Name and Site Address U.S.EPA ID Number (D <br /> RECOLOGY HAY ROAD NOT APPLICABLE <br /> 6426 HAY ROAD-VACAVILLE,CA 95687 <br /> Facll 's Phone (707)678-4718 y <br /> 10.Containers 11.Total l2.Unit 0 <br /> 9.Waste Shipping Name and Description <br /> No. Type Ouantity WtNol. (D <br /> cc <br /> o ` /� C F <br /> so U a 0 O ao y ° <br /> 3. 0 <br /> O <br /> - O <br /> a <br /> 4. fy <br /> CD <br /> 13 Special Handling Irxstnlctons and Additional InformationS # Q t e Q 0 <br /> C�7 ° <br /> O <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare That the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified packaged. <br /> marked and Iabelediplacarded,and are in all respects in proper condition lot lranspon according to applicable mfemalional and national governmental regulations. ti,y <br /> Generator slOheroes PrinleNfyped Name Signature <br /> Month Day Year /O <br /> 15.international Smpmems ❑ Q. <br /> Import to U.S. ❑Export from U.S. Pon of <br /> Transporter Signature dor exports only 1 Dale leaving U.S.: 1ppc�� <br /> 16.Transporter Acknowledgment of Receipl of Malerials J <br /> ¢O TranspoM1er 1 PrmleNTyped Name Sgnature Month Day Year <br /> n <br /> ~ n <br /> Transposer 2 PrinlcdTyped Name Signature <br /> ¢ I 9 Month Day Yoar C (D <br /> 17.D¢uepancy -- _'4 D n <br /> O <br /> 17a.Discrepancy Indication Space <br /> ❑Ouentity ❑Type ❑Residue ❑Pamal Rejection ❑Full Relecfien <br /> _ Mandev Reference Nwnbr, m <br /> I7b All—Me Faohry for Genemlod U.S.EPA 10 Number C <br /> O <br /> r¢i. Family's Phone (Q .p <br /> W 171.Slgnmun,of Alle—le Facday for Generator) ^ <br /> i Monm ea <br /> Day Yr , n <br /> (D w <br /> Z <br /> Q IN[)nswdnnlc0 Farrlxy O+.nnr m(lperxni Clrl a., r<�pt,!rnatciinl:c.•.ered b'r exCcpl a5 soled In Item 17,1 <br /> �` Prmlrti lItit+l ll:rr.. ---- O <br /> _ $wnalW¢ __ <br /> M mlh (`av v :3 <br /> (D <br /> D TED FACILITY NEq <br />