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NON-HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number
<br />N/A.
<br />2 Page 1 of
<br />1
<br />a Emergency Response Phone
<br />877.2564265,,
<br />4. Waste Tracking/N*4..
<br />2242:6904001,
<br />5. G4 ., r, Des . oddre Genointor's Site Address (II different then (Paling 44(04 ', •in , •,,...,, titiNi65.01,41430
<br />4tk15206:
<br />Generator's Rule: 269-937087.1304. 7
<br />0 Transporter 1 Company Name U.S. EPA ID Number
<br />Ponder EtwIronririef*Swvices 1 CAR.00.04,3013 7
<br />Transporter 2 Company Name U.S. EPA ID Number
<br />I Ge
<br />Facile
<br />Dated Fa :. . g flj Address U.S. EPA ID Number
<br />
<br />. tali,L,; z•
<br />
<br />'s phone 707432.4427,-- CAROVA. , • -
<br />Waste Shipping Narno and Description 10 Containers t . 1 Total 144:
<br />No. Type Quantity Vi(Nol.
<br />t'ttS: 1, ' .. •
<br />ily'•'..iA.•::7 - , 7 ,' -...- 2 ' - • ','I' - ' . '' .'
<br />CM , —7:7,—,T, 1:...4, .,„,,
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<br />1 151446411M811017326ittl?'' . 17g6r.tatin'11191*Itin
<br />lablk21202.91
<br />' GPiERATOR'S/OFFERpga.pERT1F164110iii l' hereby, declare that the contents of Ilils consignment are fully and accuralaly described obeve byte proper shtpiiig nem; and are clersOred,Pkiraged,
<br />.rtiarked and labated/prpierdec'tt'endareth ell teepricts In proper condition for transport according to appcattle international nod national governmental rogulallonS "
<br />Generators/Offeroes PripOTYped Rath Sonata; M 11'4. „flay Year -
<br />... -1.. el.. A 6 - Z . • . 0 C-4) ,4"roc.-gro I U 7- •
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<br />IntemrOon • Stepreenla El to .0. ii Export Itorrill,S. fottof .errfryfexill
<br />Transporter Signature (for exoorts'enly): ,Datifeaiing.U.S,: . - iii4NSOORTE_ R 16, Transporter' AckneYttedOmerif Ctilec,erpt#M4litials
<br />T ,1 Printed/Typed NAM° 1 Nigity.:flj;„;,.00:„ 1 ., iMer11,11.., , Year
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<br />Transporter 2 Prin yport Nome Signature 14enth Day Yaw . .
<br />I 1 I
<br />te.0.*:
<br />,174, Diecrepancy IndtcaSon Space r--t . 1_1 Quantity Type LI Realdue LI Radial Rejection FAN Selection
<br />_ Manliest Reference Number:
<br />riltr.. Alternate Facility tor Generator) U.S. EPA IONtan,t?er
<br />:*Faclity's Phone:
<br />17e. SgriatirleANternalP. fork Of Orer41°1 Month Day - Y r.
<br />khr • .
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<br />18. Designated FacilAy Omer or Operator ertifice elpt ot (parents covered try the mandesi except noted I 17a
<br />PrIntedayped Name Signe
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<br />1 69-LC-O6 10498 (Rev: WS)
<br /> DESIGNATED FACILITY ib G E OR
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