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NON.HAZARDOUS <br />WASTE MANIFEST <br />1. QapAter ID Number <br />rlbat <br />2. Pegs I of <br />1 877-256-8265 <br />3. En-taros:pi fles_conse Pima <br />. <br />4. WJste Tracliml4ymber <br />22-26029Z007 . . , <br />'.3:.'1', ;'..s. Viiiiapa1 wows Divhion Generator's Site Address (if different than mailing address) <br />Stoc00144152D6 ..64 . - <br />Gonerator's Phan 011F •13700;' <br />I% vsiirl Cirneptggriataileinte U.S. EPAID_Numb_e 7 ._ Services, 1 CA a a a a 1 a a 3-7 <br />Transporter 2 Company Name U.S. EPA ID Number <br />I <br />Facilit t's <br />!3'.'D'itiiitlitirlaiirdess <br />tti6kiiiiiiiiti*Ln.0,-- <br />U.S. EPA ID Nienber <br />tilibn city; -c,k94sesa:y . <br />Phone: i. ' ?"470.tlY4PL+' ' . t. -CA R.° 0:#949:456 ' <br />. 9 YiRSte Shipping NameaprdPeacdpIlon 10, Containers ... <br />yt,Tatal la OM <br />.... ii,1;., OTIL,a4,19—°1_0111.4.8.-".0.Mqt4*°,1.1MPP14.044rt , <br />— 0 <br />.31,? ',..#4'"It <br />" <br />i <br />. t .Ir <br />*HO, - ' • , <br />, rt• 0 ' <br />::- ri•-. Np ... <br />„,. <br />4 f4 k....- .. ro,.. <br />13 31Y010044444teLeS A51 i9rial Inlogriallon. • <br />Pdt175268V1 , .,.., MI2246029. f, 6,QC 11 q.L _ .. <br />14, GENEBAT0 vc.nmosURTIFICATIQ0r0iprobyclOare that the conleets ot itia consignment are My and eCckfrately described abae by Purp as sliPPina ROIL 411dAle el404016:kifiett marked an4 . -ottig. 00 Arg.tri 4it *Kis laptop* condition tor:Ira#3P9ti 45,9109 10-aPP4e4ialVell9nebind national governmental ' <br /> <br />qa119fatorWP.NO74Atitti*N400 . <br /> <br />vl.. a, • 40 1 tl, ..kre <br />Signarureç 14citan . Del, Year <br />.41111.—Pr ',...i <br />k ., <br />15: felereellociel <br />In1P6r1 I° ". <br />Export born U.S. . Transporter Signature ((or exports onlYlt DateleaviiikOS.:, <br />I I; <br />:O. <br />,0,41; <br />..g.' <br />1 <br />Transpoder Acknowle*tent'el ii,a.riptot getpripla ,. <br />r 1 Printedrrypedllanje 1 <br />.. . .— . <br />Signature <br />‘4ir' / <br />Iti91. NY <br />°. nS'pOtter 2 PrInteditypeOarea Signature M Day Month Yea Tra <br />.1 1 <br />9Isqrt"Pn0a - <br />, . DESIGNATED FACILthe..----- . . lin, Discrepancy Indication Space 1---1 t—IQuantity El Type El Residue <br />Manifest Reference Number. <br />1111 Sadie? Refection 0 Full Selection <br />176. Alternate Fao (or Gelltratol U.S. EPA ID Number <br />Fectlity's.ehonet <br />17r..... SIgnaluie of Alterrfalefaaty:(or Generator) .MrU Dy Year , <br />a A.• <br />18. 00011810d Facility Owner or Operator: Cortilicao sire p105l Ie4oln carded by the manifest except as noted In bent 17 <br />--4..,.., , Prtntedayped Nellie Signature <br />_--7 <br />' <br />DESIGNATEp MC011'10 GEt461ATOR 169-BLC-0 8 10498 (Rey. 9109)