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I <br />I. Generator ID Ithmilse r otos] <br />1 Garteratetsparne arui M .Addresii . . _ antaitilta • • • Wan Divistal ./ VVOS4 I; a abiammttft <br />Generator's Phank• <br />Tranaporter 1 pern¢any Narita. <br />Feltd10 ErMnnunmal aftficei <br />LI ;1.4 <br />, .. ii:.. '7;• - • :4 ,. <br />i,....:':va,;... <br />..1'11,1 nsfr.dd n" <br />Tgasposter <br />C,Ts <br />Designated Nay Name arid • <br />110.5°,t r • • Rd tra VIsta, 94,57i <br />FacIttv'e Phorux <br />; <br /> <br />1 2. Page I & Emergercy Ras <br />B.4. Waste Traoldng Number <br /> <br />1 7725265 I 22.26a2oosl <br />Generators She. Address (I1 different than mailing cans) <br />NON41.AWDOUS <br />WASTE MANIFEST <br />U.S. EPA ID Number <br />I. CA40001110737 <br />N/A <br />1 n <br />169-BLG-0 6 10496 (Reir.'9/119) • <br />a u. <br />%.1 16. Intemattonal ShIgnenta :, 0 holt to IA" <br />— Transporter &Mature Or onhit*- <br />tc 18. Weave pi Adaiiteledginent at R pt of f.tiiiertals <br />A ( <br />• 4i,r4 • ,i1S" 18. Designated Fadffly Owner Of Oisaraton Cediftrallon of 'receipt 0:slated* covered by the manifest except as noted Ds Item 97a <br />Pdritedityper9Nanto <br />Transporter 1 Pentad/Typed Marne <br />d ci-PS <br />14. GOlt R OFFERDIVSCERTIFICATION: I hereby declare that the contents of thb cOnsIgnment are fay and accurately &sorbed above by tha proper thIppIng name, aril aro clasattlids peOpjjed, marked end tabeVdIplacanled, andAre In al raapects In proper cerulItIon for hamper! wording to appitcabto international and nallonal governmental regetations. <br />Grin orators/Offeror% Pailadllyped Name • • ' 81g:tattoo <br />!0.•14.. <br />••••••• <br />'&•) <br />13. <br />Man <br />2. <br />Wastp.Stipping Naio Dascrtgon <br />1. 146444124atit. Ttitaer Ltrilga 07 WOO) <br />er 2 Prin <br />22.1aiki9 <br />InstructIond and Addtronaf trdommtten . • <br />ped <br />nl:/cu4A /14:. 1 <br />7. <br />)1; <br />C:1 Export from US. Pert ol entry/exit <br />6114444 <br />" 2 <br />A.(40 <br />'rr! • Ark <br />Data taming U.S.: <br />No. 'Type <br />Contalnam <br />, <br />Total <br />algtilY • <br />to 0 <br />Month Day Y <br />d.h iz 21- <br />121E1 .1.3 1-'1 2.7k. <br />=Vol. <br />0,* <br />7a,s•,7 <br />• <br />A•Nt, rave, <br />"ifir" • ,$•• - -4:10 • <br />Month Day Year <br />I 24 71 <br />TRANSPO EF! #1 <br />Month <br />Month Day <br />I ' <br />r <br />litty•s•1; • <br />re--, :24' <br />; <br />I <br />Year <br />• <br />;TA <br />qi• <br />Year <br />AZ1, <br />S A I <br />US. /EPA ID Number <br />tr.C4';;t1r.•14.1 54,47r",r 'T .* • • •, <br />Ptis <br />••>: <br />,r4 <br />•