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NON HAZARDOUS <br />1. Generator ID'Number <br />I <br />2. Page 1 of <br />I <br />3. Emergency Response Phone. <br />4. Waste Tracking Number ` ` <br />WASTE MANIFEST <br />I <br />s4 .r_�� <br />5. Generator's Name and Mailing Address t Generator's Site Address (if different than mailing address) <br />A± Edward rd ` btree <br />' <br />�^R + of Saga Art � 1rl rAn na 4r rr >E rr ti Prorjed. <br />20 We Center Plaza M-38 2245 S Main Stre4t <br />Santa Ana C,+ 92701 Santa A no f;YA 92707 <br />Generator's Phone: _ -7 1 A -P 4 <br />6. Transporter 1' Company Name' P' _ U.S. EPA ID Number <br />Ewl, tgyr Coi'drPt tndusttes - C A R 0 0 0 2 0 r 5 3 1/ <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 />Awnal Pteglonai <br />Landfill <br />1:100 Shyltne Blvd. <br />gvsnal CA 9.3 <br />Facility's Phone: 659 SES-5844 <br />9. Waste Shipping Name and Description <br />10. Containers <br />11. Total <br />12. Unit <br />No. <br />Type <br />Quantity <br />Wt.Nol. <br />cc <br />1' Nom-Hazard6Us i 6te# Scdfd dTranste Pip* <br />' <br />O <br />' <br />� <br />cm� <br />� <br />.r# Vic, <br />•; �"W�'Y''`"�r�:�tt��41 rr,.:"-''�"'�'�sq"", <br />iJ �f <br />2. <br />2. <br />4•y,"" <br />.- <br />13. Special Handling Instructions and Additional Information <br />wc—a r Pt:i' p� --: PPE wh1.lf:-- ha: dl.Itng. <br />9b.li Approval# AV-23-96 <br />Poo# LR1.1-332L►23 <br />14. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br />General )r'slOOff'er'oes PrintediTypl Name Sigma Month - -DaV Year <br />A PA <br />i— <br />15. Inteffidonal Shipments 1' <br />❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: - <br />Trans orter Si nature for exports only): Date leaving U.S.: 6 L/ <br />r¢ <br />16. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/ryped Name Signature Month Day Year <br />=.=,I DO (z.o 12) '� �� c � <br />y <br />ilia N' �-- 1 j f -)- 7-? <br />a <br />Transporter 2 Printed/Typed Name Sigpature Month Day Year <br />tr <br />F <br />17. Discrepancy <br />17a. Discrepancy Indication Space ' <br />❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />x- <br />Manifest Reference Number. <br />17b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />tai <br />Facility's Phone: <br />w <br />17c. Signature of Alternate Facility (or Generator) Month Day Year <br />a <br />z <br />a r^ « <br />m <br />18. Designated Facility Owner or Operator. Certification of receipt of materials covered by the manifest except as noted In Item 17a <br />Printe&Typed Name Signature I Month Day YeaY <br />169-bL6-0 6 '10498'(Rev. 9/09)' ` Y y TRANSPORTER #1 <br />