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HomeMy WebLinkAbout1433 UNION AVE (2)SOULS ENGINEERING, INC. 01 IE For: CLEANUP OF 1433 UMON AVENUE in BAK EII SK EILD CA Volume 11 Prepared ]Fore City of Bakersfield Economic and Community Development Department 1600 Trunxtunnn Ave Suite 300 Ba kersffIlelldl, CA 93301 Attn: David Lyman Prepared By: Soils Engineering, Inc. 4 400 Yeager Way Bakersfield, CAS 93313 File ICY®. 08- 12638e November 2008 4400 YEAGER WAY 0 BAKER$FIELD, CALIFORNIA 93313 0 PHONE (661) 831 -5100 0 FAX: (661) 831 -2111 QSOILS ENGINEERING, INC. CORRECTIVE ACTION REPORT T For: CLEANUP OF 1433 UNION AVENUE in BAK ERS FI EILD CA Volume Iff Prepared ]For: City ®f Bakersfield Economic and C®muarn>lunity Development Department 0 1600 Trauxtuun Ave Suite 300 Bakersfield, CA 93301 Attune David Lyman ]Prepared Icy: Solis Engineering, ff ne. 4400 Yeager Way Bakersfield, CA 93313 File No. 08- 12638e November 2008 0 4400 YEAGER WAY 0 BAKERSFIELD, CALIFORNIA 93313 0 PHONE (661) 831 -5100 0 FAX: (661) 831 -2111 SOILS ENGINEERING, INC. Appendix C Disposal Weigh Ticket 'Wally from McKittraclk Waste Facility & Non-Hazardous Waste Manifest's (Volume I & Continued in Volume 11) 169 -BLC -0 6 10498 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR NON - HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking N r WASTE MANIFEST J O 5. Generator's Name and Melling Address Generato a Site Address f different than mailing address) CITY OF BAKERSFIE:LD C1TY OF BAKERSFIE.LD y, { 1168q00� TRUXTON AVE SUITE. 300 1433 UNION AVE Generetof's-Pho lELD CA 93301 BAKERS'FIELD CA 93301 6. T porter Company UI�D fmbgv�_� 7. an orter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIOUID WASTE MANAGEMENT, INC. 56'A3 HWY 58 NORTH C A D 9 8 0 6 3 6 6 3 1 KITTRICK CA 93251 's Faclli PhoMC 9. Waste Shipping Name and Description , v 10. Containers 11. Total 12. Unit No. Type Quantity Wt.Nol. °C •, NON HA7,ARDOUS WASTE; SOLID (5011_ WITH PETROLEUM HYDROCARBONS) I DT 15 Y JnAriaArA fit W " s 2.� y i 3. F . 4. ��l+�Ir�•�a�P•�G•j�yfi {ale � ,�•1: 13. Special Handling Instructions and Additional Information �k .f 1. 106504CA 14. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Prin drr yp so Name /I,. os � - Month Dq Year F 15. International Shipments mport to U.S. ❑ Export from U.S. Port exit: Z Transporter Signature for exports only): Date leaving U.S.: - cc LU 16. Transporter Acknowledgment of Receipt of Materials T sporter 1 Pnn d/Typed Name Signature Month Day Year Q a Tranrporferg Printed/Typed Name Signature ffonth ETay Year 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity El Type ❑Residue El Partial Rejection El Full Rejection - Manifest Reference Number: r� 17b. Alternate Facility (or Generator) U.S. EPA ID Number 7 V LL Facility's Phone: Q 17c. Signature of Alternate Facility (or Generator) Month Day Year Z .Sk+,s`d $Sa X..a # �F, M, "`. i°3i 8'y +.e"a '%°,," v'}.W ffi" ',! �' "A ""': r R� i 4.� � �*", 4� St�a.0.� WE •,9 ;��i r" �f; il. zR��i ��w �XRS �'E �.S ��'°b�'t°• ., ��in;_ �'C� 9µ,. ' Vii;, N•:oi." g '�# lih ?�'a"s+ r,rr' o�Designated Facility Owner or Operator: Certification of receipt of mat s cov ed by the manifest excepi a noted if Item 17a Printed/Typed NafFe . Si ature D Y 169 -BLC -0 6 10498 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR 169 -BLC -0 6 10498 (Rev. 8106) 6� DESIGNATED FACILITY TO GENERATOR NON - HAZARDOUS 1. Generator ID Number 2. Page 1 of --] 3. Emergency Resi5onse Phone 4. Waste Tracking Number WASTE MANIFEST E X E M F' T n 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) CITY OF BAKERS RELD CITY OF BAKERSFIELD '1600 TRUXTON AVE SUITE 300 143;1 UNION AVE BAKERSFIELD CA 93301 BAKERSFIELD CA 93301 Generator's Phone: 66 r F rans 6. T rter 1 C an ame U.S. PA I um bar Zi( % ✓ `/ Y v 7. trarAporter Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC 56533 HWY 58 NORTIA C; A D 9 8 0 6 3 6 8 3 1 MC KITTRICK CA 93251 Facility's Phone: 66 1 x , 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity Wt.Nol. 1. NON HA?..ARMUS WASTE SOLID a (SOIL WITH PETROLEUM HYDROCARBONS) 1 D'f 15 Y 2. i� ,521 3x� c r7; 4 Lxy }} i +'ihZ :g S NON 13. Special Handling Instructions and Additional Information 1. 1 06504CA 14. GENERATOR'S CERTIFICATION: I certify the materials described Above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. General rs P 'nted/Ty d Name Signatur Month Day Year i 5. Internati nal Shipments ❑ 14/t. U.S. ❑ Export fro o entry/exit: ? Transporter Signature for exports only): Date leaving U.S.: r¢ 16. Transporter Acknowledgment of Receipt of Materials Tra porteW rinted/Typed Name ure Month Day Year �` ! en � �— Tran orter 2 PrieediTyped Name Si re Month Day Year t- 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity 1:1 Type El Residue ❑Partial Rejection ❑Full Rejection IManifest Reference Number: 17b. Alternate Facility (or Generator) U.S. EPA ID Number J_ V a Facility's Phone: w 17c. Signature of Alternate Facility (or Generator) Month Day Year Q Z D �'k 16. Designated Facility Owner or Operator: Certification of receipt of materials covered by the manifest except as noted in Item 17a Printed/Typed Name Signature Month Day Year 1 D 169 -BLC -0 6 10498 (Rev. 8106) 6� DESIGNATED FACILITY TO GENERATOR 7FaB s c CWMI l v �• off 169 -BLC -0 6 10498 (Rev. 8106) �-� - DESIGNATED FACILITY TO GENERATOR NON - HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Number c _ WASTE MANIFEST 5. Generator's Name and Mailing Address G'srierato s Site Address (f different than mailing address) CITY OF BAKERSFIELD CITY OF BAKERSFIELD 1600 TRUXTON AVE SUITE: 300 1433 UNION AVE h IE=LL} CA 93301 BAKERSFIELD CA 93301 Gene 6. Transgorter t anyy N 0 U. PA I Numbs S . 7. Tr an o Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 565n HWY 58 NORTH C; A D 9 8 0 6 3 6 8 3 1 MG KITTRIC:K CA 93251 Facility's Phone: 7 9. Waste Shipping Name and Description Containers. 11. Total 12. Unit o, No. Type . Quantity WtJVoI. a f Y N HAZAROQUS WAiTF. -901-ICI ( IL WITH PETROLE -IJM HYC>f2CK;ARBONS7 1 OT 15 '( W r` 2. 1 .x 3. ti �,, .A;�,.(mf .+x•^.i9 �jy���4, dam -_?,, a��1� H 4. 13. Special Handling Instructions and Additional Information 1.106''iO4C:A r 14. GENERATOR'S CERTIFICATION: I ce ify the materials described abow on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Gen a Signature Month Day Year /( /J{ /� /y/pjd Na �� �/OHero(r''ss / /{ /! J�/ /Af 15. International Shipments ❑ Import to v. ❑ Export from U.S. Port of entry/exit: Transporter Signature for exports only): Date leaving U.S.: r¢ 16. Transporter Acknowledgment of Receipt of Materials r port 1 Printed/Typed Name Signet urn Month Day Year O CL 19 L/21 Z Tra rter to ype N e Signature Month Day Ye r s 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. r 17b. Alternate Facility (or Generator) U.S. EPA ID Number V ua. Facility's Phone: a 17c. Signature of Alternate Facility (or Generator) Month Day Year s. Z r_s y $ i a 2 y 3 tE M H N d ; iy vS j �, ,u � �•�� � ���; r � �; a ; 216 18. Designated Facility 0 er or Operato . ertifcation of receipt of material vered by t -Manifest exc t a Item 17a Printed(ryped Name ign ture h ay Ye r =_V4 p e 11 i 169 -BLC -0 6 10498 (Rev. 8106) �-� - DESIGNATED FACILITY TO GENERATOR mfol"00440 169 -BLC -0 6 10498 OWV- /'06) c�� v DESIGNATED FACILITY TO GENERATOR NON- HAZARDOUS 1. enerator ID Number 2. Page 1 of 3. Emergency Response one 4. Waste Tracking Number WASTE MANIFEST 5. Generator's Name and Mailing Address de4raiVs Site Address d ifferent than mailing address) CITY OF BAKERSFIELD CITY OF BAKERSFIELD '16(10 TRUXTQN AVE SUITE 300 1433 UNION AVE s Generator s FPhone ll 1 -D CA 9330'1 BAKERSFIELD . CA 93301 60 nsporter 1 Company me U. PA Number JC_/ 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A D S 8 0 6 3 6 8 3 1 Facility's Phoii6C KITTRICK CA 93251 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity WtJVoI. ¢ NON HAZARDOUS WASTE SOLID a (SOIL WITH PETROLEUM HYDROCARWINIS) DT 15 Y I M � w . r r r• t W 2 3. ' L 4h'3Eta.',rt(F -'.#'P 13. Special Handling Instructions Additional Information and 1.106504GA 14. GENERATOR'S CERTIFICATION: I certify the rn vials described above on this manifest are not subject to federal regulations for reporting roper disposal of Hazardous Waste. G oest r Print yp d me Signature M Day %� i Lam- �Yepar la�_e_ z � 15. International hipments Import to U.S. El Export from U.S. ort of Trans orter Si nature for ex orts on :. Date leavinq U.S 16. Transpo er Acknowledgment of Receipt of Materials �a w Tr port 1 P 'nted1Typed Name Signat Month Day Year rn Tr p rter2 PrintedlTyped Name Month Day Year F- 17. Discrepancy 17a. Discrepancy Indication Space ❑ Type 1:1 Quantity YP ❑ Residue ❑ Partial Rejection ❑ Full Rejection 1 1 Manifest Reference Number. 17b. Alternate Facility (or Generator) U.S. EPA ID Number f t. U LL Facility's Phone: Q 17c. Signature of Alternate Facility (or Generator) Month Day Year z r1r 7'v. ...�.jt�k �`Y{ L �,a � �y�ytt�(�0t �` �,'a R. iS £��'�S°';$"' •T� �� .w" ¢ � � W e i++w"4 �y���. 'k^`s` l '��� . i . "�"k``'3�„� °' `Y,. .'�t ka � � ��?" �y�%��':.pn'c� '�.F ... ' �„ °i .rj '4.r:Y'�C'h '�� `�,"•y'y °,A j'$ 4.' 3, �,,: � k � ;awt4• t. es.S. v^z'k ,},q vd' „�.' - 18. Designated Facility 0 r erator: Certification of receipt of mate' Is covered bi the manif exce t as in Item 173 x Printed/Typed Name S ature M th D� Ye Q 169 -BLC -0 6 10498 OWV- /'06) c�� v DESIGNATED FACILITY TO GENERATOR CVVMI 169 -BLC -0 6 0 98 (Rev. 8106) `� v� DESIGNATED FACILITY TO GENERATOR NON- HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste TraSOV Number WASTE MANIFEST E X E M P 7` ( R001 4_ 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) d CITY 01= 13AKErRSRELD CITY OF BAKERSFIELD 11600 TRL.IXTON AVE SUITE 300 1433 UNION AVE BAKERSFIFLD CA 93301 BAKERSFIELD CA 9'3301 Generator's Phone: 6. Tra p or 1 Company Name r U.S. EPA ID Number x��•e /� ,Company 7. TransporterQ✓2 Name U.S. EPA IDDN Number r 8. Designated Facility Name and Site Address U.S. EPA ID Number LQUID WASTE" MANAGEMENT, INC:,. 56533 HWY Safi NORTH C A D 9 8 0 6 3 6 8 3 1 MC KITTRIC K CA 93751 Facility's Phone: 6611 - F _ 7 186 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity Wt.Nol. cc Q NON WA7ARD011S WASTE SOl.lD .{, (SOIL WITH PETROLEUM WYCiRC}CAF�L3ON.S) ! DT 1!i Y W t µl �y pp/�� 106504CA ,„`��}` 2. 3. g . Mil s RIM 13. Special Handling Instructions and Additional Information 1. '106504C:A 4 A. L 14. GENERATOR' CERTIFICATION: I certify the materials des ^d above on this manifest are not subject to federal re for reporting p er disposal of Hazardous Waste. OH s ed/T ed Nine / /o /j `� Si Da Year r vl J I= J15. International Shipments pod to U.S. ❑ Export from U.S. Z Transporter Signature for export: ont Date leaving U.S.: cc 16. Transporter Acknowledgment of Re i Materials ' r p Printed/Typed Name I , Si atuM re _ _ Month Day Year Transporter 2 Printed/ Typed Name Signature Month Day Year 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity ❑Type El Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: r 17b. Alternate Facility (or Generator) U.S. EPA ID Number J v u. Facility's Phone: W 17c. Signature of Alternate Facility (or Generator) Month Day Year Q Z W �F�Vls.,. d^^Sv�r .'id.`� ;'�'r�^ �k'.$ vv' .6 `°'vv�_ 3�4d8. emu' .� '�- �" ;• a'�-��i� -r. •. ..� �y 4 � ', n TL �����, 1. Bj �we•`� :� g'*�°[ �i �W�A��� \ YY���' �'�� ��� �1�� � k. � �� ��4� "[ ``" �` '�aS�;„ � � • �''r^'�'��� '� `3y''y'".,v r �yh� . .I. kt , a: s� � .Fr' "" ��- `�'.'ks ? , t ��,' ' � �,��'ua,`n 9";�1. w e9�, .'� °'fie �- ,��.,�.'��h.. '"' v.;,.c'&�'.�, ��"`" ti x, t� ' b?`c, ��� G ' �T" r�, N�'.= �' �' i���` x��t "?"'���:�'���,,��..�- �`�`��.Y� ' "•�; � �..�r�a: >-. �.��'� � -.., .'a,=�. '..s. 4+?�.�. C°i�:;.i..' a. , ` 18. Designated Facility Owner or Operator: Certification of re of mate Is covered by the manif excep as noted tern 17a Printed/Typ ame Si nature M a e )e 4 169 -BLC -0 6 0 98 (Rev. 8106) `� v� DESIGNATED FACILITY TO GENERATOR w ii CvvMI 169 -BLC -0 6 10498 (Re 8 06) DESIGNATED FACILIffTO GENERATOR NON - HAZARDOUS 1 •Generator ID Number 2. Page 1 Of 3. Emergency Response one 4. Waste Tracking NpmbeF— I WASTE MANIFEST 5. Generator's Name and Mailing Address Generato s 96 Address if iBerent than mailing address) CITY OF BAKERSFIELD CITY OF BAKERSFIEL.D IGM TRUXTON AVE SUITE '= 1433 UNION AVE C A 9330"1 BAKF_RSFIQ,D CA 93301 GeneraforK honRFI'LD r any Name�� U.S. MA ID Number 6. TC!��IE 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAOEMi NT, INC. 56633.HWY 58 NORTH C A D 9 8 0 h 3 0 8 3 't KITTRICX CA 93251 s Facili 's PhoMG 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity WtJvoI. a NON HAZARDOUS WASTE: SOLID � (-,Oil- WITH PETROLEUM HYCIROCARBONS) 1 DT 15 Y �� [i 3, 4.r.,rt�?@ 13. Special Handling Instructions and Additional Information 14. GENERATOR'S C RTIFICATION: I certify the materials described bove on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Ge ro rin yped ame Signat Month Day Year 0, A ID .n e J j 1t. IntemationaT Shipments ❑ Import .S. ❑ Export from U.S. Port of entry exit: ? Transporter Si nature for exports only): Date leavin U.S.: cc UJ 16. Transporter Acknowledgment of Receipt of Materials ¢ Tr nsporter 1 P,'nted/T ped Name Signature Month Day Year Transporter 2 Printed/Typed Name Signat Month' Day Year 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity 1:1 Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: ? 17b. Alternate Facility (or Generator) U.S. EPA ID Number J U rai Facility's Phone: w 17c. Signature of Alternate Facility (or Generator) Month Day Year a Z C7 :o qsi 33"'L`` A >8 r S y 'i 3 'F i� S ! � ��` '3�'T'�Y',u`•'�.Z�`_•3 9���.� r��''k''� e ��$Jk �� .�5't'%., In � * ��,' n."µi�n�� � �.. ` #y., M `k: u ¢ck' { � �p ��zd'%..R�"Ra� ;� ��. q'•�` p ice, jy� �� a.i+�d . A . •'�.a�.i M:! �hL c� �` � � _ '�.`..1a7:?YS?�� ». � � '.'�..�,' m...y 18. Designated Facility erator. Certification of receipt of matyidrs—cover4i by the manifest ex as noted in Item Na Printed/Typed Name \ igna re Mo h Day ar = L q ov 169 -BLC -0 6 10498 (Re 8 06) DESIGNATED FACILIffTO GENERATOR 1",e C 169 -BLC -0 6 10498 (Rev. 8/06) r DESIGNATED FACILITY TO GENERATOR NON- HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking mbar WASTE MANIFEST E X E M rr T --ini 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) CITY OF BAKERSFIELD CITY OF BAKERSFIELD •1600 TT"2UXTON AVE SUITE 300 1433 UNION AVE � BAKERSFIELD CA 93301 BAKERSFIELD CA 93301 Generator's Phone: 66 J 859. 6. T;wqorier 1 mpany Na U.S. ID Number-J` -/` J 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A D 9 8 0 6 3 6 8 3 1 MC KITTRICK CA 93251 Facility's Phone: 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity WtJVoI. I NON HAZARDOUS WASTE SOLID ' a 11 {SOIL WITH PETROLEUM HYDROCARBONS) 1 DT 15 Y '106504GA3xd ft rg ° 3.1" Vrta ; 4. 13. Special Handling Instructions and Additional Information 1 'IM504CA 14. GENERATOR'S CERTIFICATION: I certify the materials described a ove on this manifest are not subject to federal regulations for reporting p per disposal of Hazardous Waste. Gener ror s rin yped area /y� Signature Month Day Year r . Internation I Shipments ❑ Impo S. ❑ Export from U' S. Port of — Transporter Signature for exports only): Date leaving U.S.: ¢ W 16. Transporter Acknowledgment of Receipt of Materials �— T s 1 Printed/Typed Name Signatur Mo1nth Day Year a Transporter 2 Printed/Typed Name Signature Month Day Year F 17. Discrepancy 17a. Discrepancy Indication Space 1:1 Quantity ❑ El ❑ Residue ❑ Partial Rejection Full Rejections Manifest Reference Number. r 17b. Alternate Facility (or Generator) U.S. EPA ID Number J U L Facility's Phone: Q 17c. Signature of Alternate Facility (or Generator) Month Day Year 2 � vu W O d r ,�.... '� "4 k'7i.�+ n � � is � #ix . Sy •v ...,.�.ai'. xiµ'.;* �, 31�yR,'�... .uy .'$,'��'. .., `wh � -,a cad .a`• L'ni ���.., 4'a't',s?' tl. �^ _. �a�'' � ,z Sri -i, �•���rM1� d !s *4r. °� , �t�eaa�€� �l�'� �*�� .u'° si -� 'it- s�v , �'i a:`�� .,�'",." s� .rr� � s?. _ "_ "�'� . •�yCaK.,;�"h `riY.�°3.,b '���".S',•i �^y �.'- . . x S �t�`., ���,£� . °i Via; t��"' .� S; ides, Ste" 4tn3e$ s iCg�� «id �,�.�� {�k If*"A64� N�� � h �.n X; fi` IRMa, 0, 1 :. Fi �n"� "� ����5� s9e# �vr'S 0.�� $<ITAtlp�S .di s.• .�=iw_.I',ni.' >ti��F. �%�dt��.�"> r. =": y � i'•��. .`�'Y,. ., .���� qq„„ ��yy $' ' °"°` 't". �'i.i,;$ i" 18: Designated Facility Own or Opera Certification of receipt of material vered by thilmanifest exce s n ed m 17a Printed/Typed Name - ^ �S� to Mo Day Year cl Q—JJ 1�� 169 -BLC -0 6 10498 (Rev. 8/06) r DESIGNATED FACILITY TO GENERATOR ;,7;� -9- . 169 -BLC -0 6 10498 (Rev. 8/06) vv~ �"� v DESIGNATED FACILITY TO GENERATOR NON- HAZARDOUS 1, Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Nurn6er WASTE MANIFEST 5. Generator's Name and Mailing Address Generates Site Address (ii different than mailing address) CITY OC: BAKERSFIELD CITY OF BAKERSFIELD 1600 TRUXTON AVE SUITE 300 14..'33 UNION AVE F25f-1ELD CA 93301 BAKERSFIELD CA 93301 Ge ra�hone: 6. ransp or Compa Name UA. EPA ID NjImber, 7. er 2 mpany Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 5%33 HWY 58 NORTH C A D 9 8 0 5 3 6 8 3 1 Facility's PhoiiAC' KiTTRICK CA 93251 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity Wt.Nol. cc ° q , NON HAZARDOUS WASTE SOLID Q� (SOIL WITH PETROLEUM HYDROCARBONS) 1 PT 15 Y r )F;!50 A CA zk W �t, X 2.t ���„�•{� ??�`�in�t��£,3'F"s- �p"�r�; xki:'s'.at 3. gii zw 4, sa as F S t p u 13. Special Handling Instructions and Additional Information 1. 1 C16504CA p : 14. GENERATOR'S CERTIFICATION: I certify the materials descri ed above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. G Qff"P-i. p Name I Signature Month Da Year w,• . 15. International Shipments ❑ l4dto U.S. ❑ Export from U.S. Port of ant Transporter Signature for exports only): Date leaving U.S.: W 16. Transporter Acknowledgment of Rec ' t of Materials r s rintedlTyped Name u M ith Day Year O a Q Transp rter 2 Prints yp Nam6 Sig ure Month Day Year F 17. Discrepancy t' 17a. Discrepancy Indication Space ❑ Quantity 1:1 Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F , 17b. Alternate Facility (or Generator) U.S. EPA ID Number t' J V rat Facility's Phone: w 17c. Signature of Alternate Facility (or Generator) Month Day Year Q . W�+,i�, 0 �� .. �`Yf . � k * {t'sn:. �. �t. ' ^`� "rF.,,i' � '"7 • �,qY� � ' -�R ik"' >T, ixS \. `, "�2 'dC, 'x'r« � � '�.�� y �" ; u... A' ,����i'� stM"��°�' e y'S � 18. Designated er or Operator: Certification of receipt of enals vered by the manifest pt as em 17a Printed/Typed ame Signat a Month ay Year 0 169 -BLC -0 6 10498 (Rev. 8/06) vv~ �"� v DESIGNATED FACILITY TO GENERATOR 4`�-9i CWMI 169 -BLC -0 6 10498 (Re /8v 06) `-' _ DESIGNATED FACILITY TO GENERATOR NON- HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Number l WASTE MANIFEST E X E M P T 5. Generator's Name and Mailing Address Generator's Site Address (it different than mailing address) , y; CITY OF BAKERSFIELD CITY OF BAKERSFIELD 1600 TRUXTON AVE SUITE 1J0 1433 UNION AVE BAKERSF IELD CA 93301 BAKERSIF(E1.D CA 9=1 Generator's Phone: 6. TrApofer 1 Dorwany Name U.S PA I Number ... 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A D 9 8 0 6 3 6 8 3 11 MC: KITTRICX CA 93251 Facili 's'Phone: 9. Waste Shipping Name and Description 10. Containers :qQuantity 12. Unit No. Type WI.Nol. Cr o '} 1. NON HAZARDOUS WASTE: SOLID WITH PETROLEUM I DT Y� (SOIL HYDROCARBONS) W pia 106504C:A `'y1.' '..'l'Y�Q�•�ivT'°y "�.'Hi1 t.:'�ik"i 13. Special Handling Instructions and Additional Information 1. 'I0&504CA 14. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Genera prs /Offer ri yped ame Signature Month Day Year ,p, 9 J 4. International Shipments ❑ Imp r t S. ❑ Export from U.S. Port of entry/exit: Transporter Signature for. exports only): Date leavin U. cc Uj 16. Transporter Acknowledgment of Receipt of Materials Tr spo Printed/Typed Name Signa Month Day Year 4.. - c/tJ a Transporter 2 Pfintedirryped Name Signature Month Day Year cc F 17. Discrepancy 17a. Discrepancy Indication Space ❑ 7 ❑ Residue ❑ Partial Rejection ❑ Full Rejection ❑ Quantity ype 1 1. Manifest Reference Number: } 17b. Alternate Facility (or Generator) U.S. EPA ID Number J rai Facility's Phone: w 17c. Signature of Alternate Facility (or Generator) Month Day Year Q z c ��' s`t "S�s �ac.�.*a � �"����'` i`' !; +„. k^ 5 ... "�n+.a�w1�,�•;�,fl � 2 m S'qy� .; Y%e nit^aiu.* Y ,.. y �`'" „� x ��' w�i'f -. r w ^ �iS+,i ��+��x .� 'i� 3 "� #.,3.,Y�y 819,1�� "��x rte,? Si� ss ..ySM�{,�& , I �r L 'i�+s . � :y*�ta4. +S` ��- �E�b � x3�n* �*„r � p.,:S=9 @,v5 � ,Y„ro'i 4.. : � ' � r`��y" "'a'� ,�' .u� - ik `'�^v'. _, i• . &y e �i�����, vN `..°'s�byC•Y`tr6�.l°StO��L.. „`,�i.°E. °v�.is.�,:J !i. H G nctI: �'�.'A6 ti�6: g::5'".s�, -,. "H'.a`SKY"'�.2rz?a% "S`>y'�5.1 "i �" °' .x kV'� .�.wSa.. �.. °}Z... ���'e1�'.�. iC ik; ._4;. ..C' 18. Designated Facility Ow r or Op tor: Certification of receipt of materi cover d by the manif a apt as noted in Item a Y Printed/Typed Name i lure Mo Qa� Year 169 -BLC -0 6 10498 (Re /8v 06) `-' _ DESIGNATED FACILITY TO GENERATOR WME -;�'k oZ m`e <9 ; /�: T2�4 f, NON- HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Trackln Num WASTE MANIFEST 5. Generator's Name and Mailing Address Generator s Site Address (if ilifferent than mailing address) CITY OF BAKERSFIELD CITY OF BAKERSFIELD 1800 TRUXTON AVE SUITE 300 1433 UNION AVE Generator's hRoneaICLO CA 93301 0 BAKERSFIELD CA 03301 6. T n orter. Comp y Name U. PA ID Number ©� T 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE. MANAGEMENT, INC. 56533 HWY 58 NORTH C A D 9 8 0 6 3 6 8 3 1 KITTRICK CA 93251 's Facili PhoM 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity WtNol. cc o �> NON HAZARDOUS WASTE SOL 11) (SOIL WITH PEfROI -EUM HYDROCARBONS) 1 DT 15 Y I OAA . _ W �v �;'ly 2. �„� •?�Ji't5y,.,"1�' G'Y -U nFt•** y,. }+�.4,`�.}Sl?, y 3. 13. Special Handling Instructions and Additional Information 1. 106504CA 14. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous G ffer r' Pri ype Name j� Signature Month Da Yea ' Iin 1 � ► _j 5. International Shipments ❑ Imp .S. ❑Export from U.S. Porto an ry exr — Transporter Signature for exports only): Date leaving U.S.: cc 16. Transporter Acknowledgment of Receipt of Materials T port dlTyped Name Si re Month Day Year CL u Tr porter 2 Printed/Typed Name Signature Month Day Year F 17. Discrepancy 17a. Discrepancy Indication Space ❑ ❑ Quantity ❑ Typ ❑ Residue ❑ Partial Rejection Full Rejection W Manifest Reference Number: r 17b. Alternate Facility (or Generator) U.S. EPA ID Number U ri Facility's Phone: W 17c. Signature of Alternate Facility (or Generator) Month Day. Year a • n z � W 0 Yk' � ��� ��� �t •.:._ , 3 '�; �xaz � - '�' ix :�,� h+Y'' t .."� �+' i �w'° "J°� ^ti��� s•s x c^ k,.'�yr,Yr,. xq ". ".�$�,� §Z 5" X���r'"�� .��=* u,�»t�''�r .sY °g����, x"„,,�y'.` e�.,;,,d'€ "*"§"' � a ,y�, '°Y `..�� fie: < `,_# �5L�' �'`� •.�.}�R.:. •�.. _ q�.�"'°r,�.. �( �y`Z".'y�k.l., g''� S.' :�5 � '. R' #�� '`v. �� 7 }' � ^. •iiilk°� may'' k".M 1.'+o-, � �� "'t...' � y +�v�'e ." 5� i r �1,#Y�r m 5 � ,, y.}i, .�y. 'peg- i� � MSS Sv �'' ��9� °�' *�•yi �v ,pry ,,y'`�'u't t �Y `�'" � 3*x' : +�', Y i,+.@,:�v 'af' 4yf, °Nh�.. � ' ' .:a� 'kp r4), .3. .... "7' 1's^�k �•g�'x��r'R fA �$., 4wa,'ak'q. z .fi:� ` 'm. M "'. irS �v' ...:3T3 Sail ,y. }`3 i i a'P F'.Y� � '�)a!''6m•`�"1 .' 9': �"Y ;9� ��.:',!qR �A.Y� a . "�. ,a.4.� .k� .5. �„�„Et � `.,: `'a3� S'y�U„, �' ��� . •'�,?. ' • pFggX; +�k4.t_�� , .. �~{ �. My'i. jd i wk �� +i�'� Y�C"4L` >xs � �..i'� ���& q �'p��"' �Jy+. �` a� a � � '.R'. "�, E �'�, q '.�' ' ^�3' "��g�' 4.� A.. � �:+� n "'wiEN� :� {, ^`� � �.w�•,, 18. Designated Facility 0 r or or: Certification of receipt of vials cove d by the manife except no • Item 17a Pdnted/ryped Name ture Mo D� Y r ' j a 169 -BLC -0 6 10498 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR A� � 71__Pl�_ /-5Z � �/ � e /. ), L 0 - � � 169 -BLC -0 6 10498 (Rev. 8%06) DESIGNATED FACILITY TO GENERATOR NON - HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Number WASTE MANIFEST t_ X M Fo T f 1 _ Q100 7. 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) CITY OF RAKEIRSFIELD CITY OF BAKET SFIFI_D 16013 TRUxTON AVE SUITE 300 1433 UNION AVE T3AK[ SrIELp CA 93301 BAKERSFIELD CA 93301 Generator's P ne: _ 7 6. Tran o m nt Name �J/1� U PAID Nyc Y6 6I� f 4 7. Transporter 2 Company game U.S. EPA ID Number t' 8. Designated Facility Name and Site Address- U.S. EPA ID Number i LIQUID WASTE MANAGEMENT, INC. 5&933 HWY 58 NORTH C A D 9 8 0 6 3 6 8 3 1 MC KITTRICK CA 93251 t Facili 's Phone: 6611769- 7166 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity WtJVoI. NON HAZARI:IOUS WAS`T'E SOLID a ? (SOIL. WITH PETROLEUM HYDROCARBONS) 1 DT 15 Y w, 10650 4 CA k w 3 2. a3EH~ "Berl ^Si} - V ➢ L-., � x M` 3. 13. Special Handling Instructions and Additional Information 1.'I 06504C A 14. GENERATOR'S CERTIFICATION: I certify the materials de ribed above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Generat er s P edtT ed N e D Signature onth Day Year -i A. Intemational Shipments rt to U.S. ❑Export tro Port of ant d — Transporter Signature for exports only): Date leaving U.S.: r¢ 16. Transporter Acknowledgment of Receipt of Materials T nsporter1 Printed /ryped Name Signature Month Day Year O a Transporter PrintedtTyped Name Signature Month Day Year ' 17. Discrepancy T' 17a. Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 17b. Alternate Facility (or Generator) U.S. EPA ID Number J LL Facility's Phone: Q 17c. Signature of Alternate Facility (or Generator) Month Day Year z C7 ��'- �`'"�'�b+�p',,€a"� i'%'a}t'�4;:e�� � ��, ?{ ' :+ t��`��zx � �5�+.. �a �'a',6�v;�� +-`, ��gi�:r' s' . :u ,r p'�� *, ����4�• „�t � :» r 18. Designated Facility Own r Opera ertification of receipt of material vered b e manifest excep s note in Item 17a Printedryped Name Si t ture r Mo Da Y ar 169 -BLC -0 6 10498 (Rev. 8%06) DESIGNATED FACILITY TO GENERATOR 169 -BLC -0 6. 10498 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR NONHAZARDOUS 1. Generator ID Number 2. Page 1 of . Emergency RespoZimaningaddress) 4. Waste Trackln Number WASTE MANIFEST 1 1,, ` . — S 5. Generator's Name and Mailing Address Site Add ' CITY OF BAKf_RSFIELD CITY OF BAKERS FIELD 166 TRUXTON AVE SLATE 300 1433 UNION AVE f3�t�t RSFIELD CA 93301 BAKERSFIELD CA 93301 ZI Genera or s h 6. Transr 1 C pany Name U.S. EPA ID Number 7. Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A n 9 6 0 5 3 5 8 3 1 KITTRIC K CA 93251 Facility's Phoney 9. Waste Shipping Name and Description Containers 11. Total 12. Unit No. Type Quantity Wt.Nol. °C 1 1. NON HAZARDOUS WASTE SOLID } (JOU. WITH PETROLEUM HYDROCARBONS) i DT 1ti Y� d�1 �d W .t 4e, rsa uG.t M,H._F .6 yi 0 '' . YES lh ! M, 13. Special Handling Instructions and Additional Information 'I 'Ia1504CA a 3 14. GENERATOR'S C IFICATION: I certify the materials describecAbove on this manifest are not subject to federal regulations for report n j proper dkoosal of Hazardous Waste. Generator' ror d yp ame Signature M th Da %ear ' � I— 1 .International Shipments ❑ Imp S. ❑ Export from U Port of entry/exit: Z Transporter Signature for exports only): Date leavin U.S.: cc W 16. Transporter Acknowledgment of Receipt of Materials Transporter 1 rinted/Typed Name Signature Month Day Year a N / AAA d J G nspo er 2 Printe yped Name Signature Month Day Year F 17. Discrepancy t 17a. Discrepancy Indication Space Quantity ❑ Type El Residue ❑ Partial Rejection ❑Full Rejection , Manifest Reference Number: 17b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL Facility's Phone: w a 17c. Signature of Alternate Facility (or Generator) Month Day Year Z 18. Designated Facility Ow or Op or: Certificatio of receipt of materi covered by th manifest exc t as oted in Item a Printed/Typed Name n e Month Day Year ' ` 169 -BLC -0 6. 10498 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR +On's- ------- - 0 0NMI -77A�-� �L L."P. 0o/ - /o od,0 -1 169 -BLC -0 6 10498 (Rev. 8/06) u �' DESIGNATED FACILITY TO GENERATOR NON- HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Number WASTE MANIFEST E-.. X E M P T 2J 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) CITY OF BAKERSFIELD CITY OF BAKERSFIELD '1600 TRUXTON AVE SUITE 300 143:3 UNION AVE BAKERSFIELD CA 93301 BAKERSFIELD CA 93301 Generator's Phone: ( 66 11 RS7. . 7 c 6. Tra or 1 Company Npme U.S. Epp ID yymbg , 4 t ✓DG 7. Transporter 2 Company Name U.S. EPA I Numbvber`,V[C�jj�/ 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A D 9 8 0 6 3 6 8 3 1 MC KITTRIC K CA 93251 Facility's Phone: 66 7 Q - 7,166 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity Wt.Nol. o NON HAZARDOUS WASTE SOLID !a (SOIL. WITH PETROLEUM HYDROCARBONS) 1 DT 15 Y 10650404 Z LLJ 2.�t n �"re �f.�`F y`,t5,,,,.� � 'S•��`cda'S�:t?- kk.����:,�'�,a' a 3. iiLv -n' Vt G g ,v-�i. IN TM 13. Special Handling Instructions and Additional Information 'I. 'I06504CA 14. GENERATOR'S CE TIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting 1poper disposal of Hazardous Waste. Gener to ped e 0 Signature onth Day Year r v Y r i 15: emational Shipments ❑ Import to U. ❑ Export from U.S. ort of en try/exit- Transporter Siqnature for exports only): Date S.: W 16. Transp er Acknowledgment of Receipt of Materials ° T spo r 1 P inted/Typed Name Signatur Month Day Year 17 J 1 1/210 a( s ort r 2 Printed/Typed Na e i Month Day Year r 17. Discrepancy 17a. Discrepancy Indication Space Quanti ty 1:1 Type Residue ❑ Partial Rejection ❑ Full Rejection ❑ Manifest Reference Number. ` 17b. Alternate Facility (or Generator) U.S. EPA ID Number J U a Facility's Phone: W 17c. Signature of Alternate Facility (or Generator) Month Day Year a Z m _ Soh k'� 1F l°��� yi"^w ��,J�, � CX ���t���� #� , i" y�"5���, "� 11z�T vyM � #�:.3- y £ �it� � ht 'r. 3 * • �4t l��pp� l.y. p�'pn•, 3" .\ � ' � � � � � t� � R d f. � � �. '� ..'t§x � -,... , � .� Y_ ,. ..Sz . £i.. .,�£.5.... � ' ,£ _� 6 § ?� 18. Designated Facility Owner or 0 or: Certification of receipt of mate ' c eyed by the in est pt tad in Item 17a Printed/Typed Name Signature Day Ye r 1A N1, �. G(/ 169 -BLC -0 6 10498 (Rev. 8/06) u �' DESIGNATED FACILITY TO GENERATOR 4° / C:WMI 169 -BLC -0 6 10498 (Rev. 6/06) �'� DESIGNATED FACILITY TO GENERATOR NON - HAZARDOUS . 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Number WASTE MANIFEST 5. Generator's Name and Mailing Address Generato s Site Address if different than mailing address) i CITY OFDBAKERSF =IE LD CIT Y OF BAKERSFIELD. 160p{i? TRUX TON AVE ,SUITE: 360 1433 ONION AVE TSe 1 I.D C A 93.101 F3AKFRSI -IELD CA 93301 Generator's P , r 6. T sporte� o pany Name � y � � U.S. PA ID Number // ��J 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number LIQUID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A U 9 8 0 6 3 6 8 3 1 Facility 's PhoMC KITTRICK CA 93251 9. Waste Shipping Name and Description 10. Containers 11. Total 12. Unit No. Type Quantity WtJvol. ap '� g a 1. NON HAZARDOUS WASTE SOLID WITH PETROLEUM HYDROC.ARI IONS) 1 15 Y r (SOIL DT Z 2. a 3. k w Sri ta° iS'M+�' �i Y�� ,�; '�J y3i'^r"�� �}i bti`�'�.y �y;• '" 4. c P 13. Special Handling Instructions and Additional Information 1, '10004CA t14. GENERATOR'S ERTIFICATION: I certify the materials described abo on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Generat ffer r' Prime yped am� 0� Signature Day Year C , �'1 1 . International Shipments ❑Import U ❑Export from U.. ry /exit: — Transporter Si nature for exports on Date leaving U.S.: cc w 16. Transporter Acknowledgment of Receipt of Materials r porter rinted/Typed Name Signature Month Day Year R °C d A nx q Q Trans er 2 Pd tedlTyped Name Signatu Month Oay Year H 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 17b. Alternate Facility (or Generator) U.S. EPA ID Number a Facility's Phone: L' 17c. Signature of Alternate Facility (or Generator) Month Day Year Q 2 V! W � '�y.; • rY �" �"s�7"^,`.'°` "�'� '� � - a x >a �� u}j�.. •; +�� ¢�: � ��'�� �A9 $ "tdw �� � �a M � � ?��' CL Sy,' ^� � ' ^ a' � J' .., fv W� e" #:° ,,� �' ^ *% . fi��F�{ ��� ���� S�(��El�''�.�.''',?v '�A «�' � �;;�� . �3.� .F�S���u •j, V Te;_. 3'� `3,*'� v'�. g. y 18. Designated F caner erator: Certification of receipt of atedals cov d by the manifes ept as note ' Item 17a Printed/Typed N e ignature Mo Qa e r 169 -BLC -0 6 10498 (Rev. 6/06) �'� DESIGNATED FACILITY TO GENERATOR -4 aci 14- .--- -� �-- F-,e/-n 1 A / 169 -BLC -0 6 10498 (Rev. � / 6 v V v - �J — DESIGNATED FACILITY TO GENERATOR NOWHAZARUIUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Waste Tracking Number WASTE MANIFEST E X E M F' 'f ti _A n a 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) CITY OF BAKERSFIELD OTY OF BAKERSFIELD 1600 TRUXTON AVE SUITE 300 1433 UNION AVE BAKERSFIELD CA 93301 BAKERSFIELD CA 93301 Generator's Phone: 66 11 A 2 - 7.' 6. Traysporter 1 Compa y Name 7. Tra orter 2 Company Name riv U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number 1 -10UID WASTE MANAGEMENT, INC. 56533 HWY 58 NORTH C A D 9 8 0 6 3 8 8 3 1 MC KITTRIC K CA 93251 Facili 's Phone: A 6 i 7 6 7 7 16 . 10 Containers 11. Total 12. Unit 9. Waste Shipping Name and Description Quantity Wt.Nol. No. Type o NON HAIARIVUS U\tAST[ _ SOLID a (SOIL WITH PETROLEUM HYDROCARBONS) i DT 'I5 Y���� Ri ' 106504CA PUP M rya 3. Qi =P "4 LX t'� 13. Special Handling Instructions and Additional Information 1,106504CA 14. GENERATOR'S ERT (CATION: I certify the materials descriqyVbove on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Ge er s ri d/Typ d Nam �/ ® Sin _ th Da Year 15. ntemational Shipments ❑ Imp to .S. ❑Export from U. Pori of entry/exit: — Trans orter Signature for exports only): Date leaving II cc w 16. Transporter Acknowledgment of Receipt of Materials T nspo 1 Printed/Typed Name Signature Month Day Year N ✓ Lc Tran 2 yped Na ignature Month Day Wr 17. Discrepancy 17a. Discrepancy Indication Space ❑ Quantity El Type 'n Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 17b. Alternate Facility (or Generator) U.S. EPA ID Number • J_ V LL Facility's Phone: w a 17c.'Signature of Alternate Facility (or Generator) Month Day Year Z 0 ��, y • � � �... Y `S"e� �}}i' � "�� e°' � .w.. � �y�y 4 `a � �';#.� \ . � ' � '} f3i �2�rc. �.tt}S'� �� „� n,. ""a t `�•�`'h^ ^uP y- :R. 18. Designated Facility Owner Opera : Certification of receipt of materiagcovereo the manifest except al noted in em 17a Printed/1 yped Name Sign re — Mon Da Y r 169 -BLC -0 6 10498 (Rev. � / 6 v V v - �J — DESIGNATED FACILITY TO GENERATOR