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Feb 012021 5:41 pm RAH Environmental 9163674301 p,1 <br /> NON•HAWDOUS 1 1,Ganarator tD No-to 2 Poe 10 3.Errrrpency Response Phar 4,Wa.te Tnw"Number <br /> WASTE MANIFEST NOT APPLICABLE / �/G)s43•'7770 178907 <br /> 5.GnaraWs Nww U4 Us"Addmu`1 A UBS LCG/�r/�S c�L C G reretar's Site Actress{a aret e,an ma"o.dd—) <br /> I-e S. /1'a�i�.-IY 99, ;' <br /> v�vr�zE, IN r4 f/di s/y ? ///z.,/u� �,/a.✓ �•1,.r� <br /> bene afore Pna o%K�r?sz 3ssL if>�/'/dP /i . a�n r SAer�rr"✓, til ��o� <br /> 6.Tramporsw 1 CongwVy Name U.S.EPA 10 Number <br /> I./c. WT/APPLICABLE <br /> 7.Tra sponer 2 Corrryury Name U.S.FPA f0 Nrnarer <br /> h'OT APPLICABLE <br /> 8.Dl"naW Fealty Norma Cud Sao Addn.0 U.S.EPA 10 Mrrbw <br /> RCCOLOGY HAY ROAD f1OT APPL!:.AELE <br /> 6428 HAY ROAD-VACAVILLE,CA 9 S <br /> raq s Pham. 1 <br /> 0.Waste Shippey Nam snd Description 10. 11.Total 12 LkA <br /> Ho. Typo ou" WWoL <br /> K Da pr 0 C2 <br /> i3 .. <br /> W ? <br /> t7 '• ' <br /> 4. <br /> 13,Special KaMb"Ytshadiorts and A60wal lnlotrriallon <br /> eu <br /> 14.GENERATORWFFEROR'S CERTIF1CATIM.I hereby declare that the tarlenls d JhLt tonsigrmeN ata fully and a0=tety demted above by Vw proper srtOl name,and are cl ssiK padaged. <br /> mall ed and labeMoacarded,and are in a8 respads ti proper eortdalort la WSW acmr ft(a applbbte intartationel and nayoael pownvr,"l regrlatlmes. <br /> Gerreratcrs"em(s Pr6ned7yped Nair+e Synature IAonar Day Year <br /> ^ <br /> FF,.. 15.htlemabonalScion) to ern to U.S. Li Firpat IMMU.S. <br /> r P01,01envorit v' <br /> z TransWer SittiiaWre Ior exporIS - Daisleavir U.S.: <br /> Q 16.TrarsroderAd vwWdsmieN of Recelpl d Matedab <br /> Transporter I PrinteNTyped Name SfgnaNre '/7 ��� Month Day Year <br /> a TrX-Toler2PrrHcVyWName <br /> Sgutue Month Day. Year <br /> M <br /> t- <br /> 17.Discrepancy <br /> 17a DISM aney bd-,-SP" Elt�unl'ty Type ❑Rcs door ❑Partial Rejection ❑FW Re)ec8oe <br /> Mwilosl Releranca Number. <br /> Y U.S EPA pNurnber <br /> 17b.AeemataFadry <br /> i (orGerwaw) <br /> J <br /> V <br /> cai Fealify'sPhone: Mordh Day Year <br /> 17t Signatwo of Alfe, @ Faay(orGerteratot) <br /> a <br /> 18.Designated Faciy Owner or DWEItor,Cealc9tiar d recso d melartals covered by the rr4n8esl except as noted In Item 1'(a• Year <br /> MOrnh Day <br /> Pr4ftTyWNamer� <br /> - TRANSPORTER 81 <br /> 169-51-5-05 11979(Rm S/09) <br />