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07901br Lr r <br /> NONSHA?ARDOUS 1.Generator ID'Number 2.Page 1 of 3.Emergency Response Phone. 4.Waste Tracking Number r <br /> WASTE MANIFEST 8+� ;� _,yr<� t� 4 <br /> S.Generator's Name and Mailing Address ,Art EE�l;3Y[I'1a�TCe9 Generator's Site Address(if different than mailing address) <br /> " <br /> CID of SantaArlb ' 63mmorAvenut IrMrovenwrft Proj <br /> 20 C1ylc Center Plaza M-36 2Z45'4 Main Street <br /> Santa Ana CA 92701 Santa Ann CA 92707 <br /> Generator's Phone: _7 1 A ^7 .$ O _ n n i a <br /> 6.Transporter 1 Company Name' !'• U.S.EPA ID Number <br /> Ecolow-Celr> ivi industfles 4 C A R a 0 0 2 0 1 5 3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Atonal R*91onO Landfill <br /> 1100 skygna Blvd. <br /> Avenal CA 91M <br /> FacII 's Phone: :69 Wfi-5844 <br /> 9.Waste Shipping Name and Description Containers 1 i.Total 12.Unit <br /> No. Type Quantity Wtl"Jol.al. <br /> cc 1,M.,rl-Hazerdous s,ti�,soild d,'ansfte PI;*) �� " <br /> 0 1 CM <br /> w2. 3K'M. <br /> I 2. <br /> I4. <br /> I 13.Special Handling Instructions and Additional Information <br /> Nab.lz A pLoval# ANY- 23-96 <br /> P+.`si1` LRIL1320%13 <br /> 14.GENERATOR'SIOFFEROR'S CERTIFICATION:I herebydeclare that the contents of this consignment are fully and accurate) described above b the ro er sbi in name,and are classified,packaged, <br /> 9n ty Y Y P P pP g p g <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations. <br /> Genera_loest0lferces PrintediTypV Name <br /> j Si�e✓' Monlh �•Dart Year <br /> A PA <br /> J 15.InteinatTonal Shipments / <br /> ❑import to U.S. ❑Export from U.S. Part of entrylexit: t - <br /> Transporter 91 nature for exports only), Dale leaving U.S.: <br /> 16.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> IL J <br /> Transporter 2 Printed/Typed—Na—Fe Dptu or Month Day Year <br /> r <br /> 17.Discrepancy <br /> 17a.Discrepancy indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> m- <br /> Manifest Reference Number, <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Zi <br /> f � <br /> u. Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> Lu <br /> ,y <br /> 1A rr <br /> 16.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest except as noted In item 17a <br /> Prfnted/Typed Name Signature ; Month Day Year <br /> 169-kc O 6 r10498 CII ` — ANSPORTER#1 <br />