|
cc
<br />Lu
<br />NON.HAZARDOUS
<br />WASTE MANIFEST
<br />1. G°L.r.jeraal°r1D1.11-111W/
<br />MN
<br />2. Page 1 of
<br />1
<br />3. Emergency Ros.panse Phone
<br />877,256-8263
<br />4. Waste Tracking Number
<br />22.260294043
<br />Generator's "lame arri a Address GEflefalaS Re Address (if different than malting address) Oltddici,i) iitiltiea Dhislon
<br />Z W,iittt •
<br />StOdOPOCK9,5206:- , . „
<br />Generator's Phone: . 209.9374700 .,-
<br />Transporter I Company Rune U.S. gf,'A ID timber
<br />FOnderinitfrOnirgt14150104 ' . eik•ltd.0,018 473 7
<br />Transporter 2 Company Name U.S. EPA ID Number
<br />
<br />a Dos naiad Faciame. alba Address U.S. EPA ID Nambor t,i,• ..:-
<br />3675 "fillt:lit • .'...z.•
<br />Wit. 145135e0o..
<br />Feat 's Phone: 71.1704W27' :--1..`'.;:. C ARO OVAIK 40 6
<br />9. 'Haste Shipprng Name and Description ip.. co*Ots i t, Tow 12, Urit :
<br />No. Typa Quantity woo:
<br />,, ,
<br />,'
<br />.-:
<br />.- - -, 1.7. - .-.--r,7, r. "V '.. .;!'7".7.7 i'r '.-.".=, 77; .
<br />.. , GA
<br />Z 0
<br />iu 2
<br />,•
<br />,-,.. p.
<br />. ,.t. ....
<br />'
<br />.. 41.
<br />4 '
<br />13' 41611400gfin Ac!".14.4infpfmation
<br />Ptii051;68Vif:',"`'.
<br />1612246019
<br />...
<br />14. GENERATOR'5/OtfEROD' .. CER11FICATiON: 1 iietiby docidre that the contents of this consignment am buy arid accurately described above by tho proper zhipOrig name, and are classiffad,r packaaad,
<br />1114fW 0114 1900847#15.4.1114.01iiP 14 (NP11014 In ProPer.conddion for transport accordir.g to applicable international and national, governmental r ulallor*
<br />peperatoNateraft Emmyfiediroto — I Signature . . ... Month. 'Att. Year
<br />.` i
<br />
<br />6-rpe---4.1.-, l • , i..,;...,_,....,......4‘,...::-.• i...,"- ,17-.,.3 IZT 1757 .. ,,, .. ,
<br />—
<br />",...,..14.161.(I1nifillori SlirlSmiertti' r71 1.' . - - -
<br />1--0 111.1PerRO.U;& L..1 Export from U.S Fart Of entry/exit:
<br />Transporter Senator& (fOr.exPOrts only): Date feavrna U.S.:
<br />tv in Z
<br />It Transpditer AcW yopotth1tot Aa0ii.P; 9i, t!tateriels
<br />Iran r 1 Prfriggyped•ganie. Slane* Menai 'Day Y .... .
<br />A44 i) Ze / IZ
<br />Tra*Ortor 2 Printed/Typed Nam .e MOrtlii Day Year
<br />i iptLTECI TP1' , 17. Discrepancy
<br />Discrepancy Indic-aeon Space 1.-r-11 El Type El nosidue 0 Palital Rejectien 0 Full Rejection
<br />Manifest Reference Number;
<br />170. Alternote'Faaly (or Gdribliddi) U.S. EPA' 10 Number
<br />,Faglis Phone:
<br />71/o. SI(Molino of Mamie Facility (or Generator) 1/4en1h Day , Year
<br />I
<br />4.
<br />1B. Designated Facility. Owner or Operator. Cod lion of. fat pt ' materials covered by the manifest except as noted Item 7a
<br />Printed/Typed Name Stratum
<br />I L_. 201
<br />DESIGNATED FACILITY TotG 11 169-14C-0 6 10496 (Flay9/09)
|