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-r ‘; <br />. <br />., <br />NON-HAOtious <br />WASTE011.N I rgST <br />I. Oentrator ID NUmbel <br />, N/A <br />2. Page I or <br />1 <br />3. EntorgenciFleagd4e.1111.ute <br />. 87....441.04$265 <br />4. Waste Tricking Number <br />22. , 264)''.29. ,5013 ..... . . . " 5: Generators Name and blaring Acldrees <br />. CIVOttStookkiii Municfp41 Unities Divon <br />'- 7.4... WAMIttstiti St <br />' Stbiktiiii4C9,5206 <br />Grinerto?`a Ph:orre., .4tis03-8700 <br />Genataldfa-S116 AddieSifil dilrerent thin maAna eddfirs-s) <br />. 6; Transporter 1 Company Name U.S; EPA 1.Q.11plegr <br />- .:Pcnider Erwin:twat:1i Services • . C*10104110 7S- 7 7, Transporter 2 Company Name U.S. EPA ID NUMber <br />8. DesigrratedFacqity Nam end Ella Address LIE, EPA ID Number <br />Pli**Olillit*MIN <br />,367546i0iiiiillii.Ltv <br />:•Sdisikt;.C41y3-4:"CA-94S11.3 <br />rito4 i;lite:.: --'' ' ' --;'-• ' ''''. ' ' 107.4324617i;',.--- -Ckft 000.0,89A6 6 <br />9, V/aste Name and Description .Shipping IC ti Conli* 11. TrAal 1 :Unit 2. ' <br />No. Quantity WI.Nol. <br />— lil <br />.1...:•i. <br />1 <br />.1, ,N0114-fitiattiOUIS.WitSte'kiidAHYdiOalthOlfl Impacted • • :-.y. <br />- <br />.', <br />. <br />'i. <br />1,0 <br />.. i • , <br />,.... <br />13, § <br />.POtThleogifi... <br />' .. auctions/1nd Additional Infottnation - <br />• <br />2246020 . . . .., . <br />14.S "rizool— (5t1 '-i12-(- z5 k Gtw ,1, <br />014ERA_Tfrtfgfigfi'S CERTIFICATION I hereby deelare that the contents or this cOnsignMent ate tally <br />4 0.4 ape Nparded. and are in all respects In proper condition ler transport according (9_ ePplicable 1 1.01 <br />#„. accurately described above by the proper shipping name, aid are classified, packaged , <br />a atonal end n. ',nal Yemmental regulations. <br />Deriltibr t ' rtr.19:6/11iped Name O.Z-O Signs <br />/ ''' '"" - ' M% kt 7 <br />/ Month Day Yeey.:.: <br /> <br />- -- A <br />, / 11 z5 .1 zti -.1 <br />-- <br />15. InlektallOrgilStiOrterod tmport Ip U.S. II Expoil triim ' S ?b el entry. , , if r ... <br />Transporter Signature (tor exports only): Dabs leaving 4.8,', 1 i4AtisOORTEFt: 18 Transpoderi,tclinotirtodgment at Receipt of Materials . <br />Transporter t•Pdglacirrtyped Name Signature <br />witxklita____b%).,,kkem I A A . ii.' i <br />.Mbibb <br />,. . Jt. ." <br />pay .• <br />' • <br />transporter 2 Pririt yped Name Signature Mollth Day Year <br />I DESIGNATED FACILITY... 17! Dltereparicy <br />17e. DIsOrepaiicy IrcketIon Seace 11 L--.I Quantity E Tyde El Steidtre <br />Market Referee:a Number: <br />111 Partial Rejection II Full Flitikeoh <br />1711.-Atrenfato'Facig8y (or Generator) U.S. EPA ID Number <br />Facik's Phone: <br />tic. SignatUte at Alternate Facility or Generator) Month Day Year <br />18. pesignated Facility Owner or Operator Denilicallon . ace() of turfs's covered by the manifest except an noted in Item 17 <br /> <br />Pentad/Typed Nente Signature ' <br />I IA <br />1 69-8LC-0 6 1049/1-(liev, 9/09) <br />DES* <br /> <br />0 FACILITY TOIIGENERAT6Iit/