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INTL 1 GENERATOR NON•HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />...AOC/7662667e <br />2 Page 1 of 3. Emergency Response Phone <br />9215-432-6102 <br />4. Waste Tracking NumbeL ,1.--. c.) — <br />USW—L) (j j 5 4:-:3 ^ <br />5 Generators Narne and Mailing Address Generator's Site Address lit afferent than mailing address) <br />00W CHEFAir.',A1. <br />901 LOVERIOGE ROAD <br />PITT SOURB. CA 9.4561 <br />Generators Phone 226432-5102 <br />6. Transporter 1 Company Noise U.S. EPA ID Number <br />7, Transporter 2 Company Name U.S. EPA ID NuntlAr <br />8. Desig aicFayNne and Site U.S. EPA ID Number k t jor t ti <br />C A0931 /t 2? 1.12. 10840 ALTAMONT PASS ROAD <br />overt moR e. CA .945131 <br />Faceirys Phone: 925-41-5-7300 <br />9 Waste Shipping Name Desorption and 10 Containers 11. Total 12 Una <br />No Type Ouantity Wt .:Vol <br />1. SPENT CAR1E1ON NON HAZARDOUS/NON REGULATED 2O71.R15 <br /> 1 <br />g T:/). 7 )0 6 kii 1111 IR lig litk <br />13 Special Handling Instructions and Additional Information <br />NeerIS CO SENT TO us wAsTe 24 HII EMERCiENC 'r CONTACT LARRY LL.PN. ANC/ 225-432-51012 T' <br />C AL OCN CARBON CORP• STOCKTON. C., <br />rill er -liz,riez. 1 720c.,# 1-11701 30 r75- - . <br />14. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare Mat the contents of this consignment are fully and accurately described above by the proper shipping name and are classified, packaged, <br />marked and labeled/placarded, and are Cl all respects in proper condition for transport according to applicable International and national governmental regulations. <br />Generator's'Offerors Prtntecayped Name Signature Month Day Year <br />I 2 I -;" <br />15 International Shipments import toys Export .. II from U S Port of entryexit <br />Transporter Signature (for exports only) Date leaving US ' TRANSPORTER 16 Transporter Acknowledgment of Receipt c4.Materials <br />Transporter 1 Pnnted/Typed Name Signature Month Day Year <br />i <br />Transporter 2 Printed.Typed Name Signature Month Day Year .1- DESIGNATED FACILITY -110. 17. Discrepancy <br />Discrepancy Indication Space . Quantify 11 Type . Residue . Partial Rejection . Fa Rejection <br />Manifest Reference Number: <br />Alternate Facility (or Generator) US. EPA ID Number <br />Fealty's Phone: <br />Signature of Alternate Facility (or Generator) Month Day Year <br />18 Designated Facility Owner or Operator. Certification of receipt of materials covered by the manifest except as noted in Item 17a <br />PnntedTyped Name Signature Month Day Year <br />I <br />169-BLC-0 5 11977 (Rev. 9(09) <br />GENERATOR'S/SHIPPER'S INITIAL COPY