Laserfiche WebLink
: I <br />el <br />G <br />E <br />N <br />E <br />R <br />A <br />T <br />O <br />R <br />W <br />a <br />A <br />NrI-HAZARDOUS WASTE MANFEST <br />NON -HAZARDOUS 1. Generator's US EPA ID No. <br />WASTE MANIFEST <br />Pnntedrr?r Name Signature <br />✓ t` 1-i ls <br />tttiLU <br />Document No. H <br />Manifest N 4527 <br />NH <br />Page 1 <br />i <br />Generator's Name and Mailing Address <br />of I <br />Y 7V <br />W. 6- <br />%`t E: lir C)- <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />4. Generator's Phone. )q�r-341 <br />-77 (— <br />% Y�3-76 <br />Name Signature <br />/ �� <br />:;4� <br />Month <br />5. Transporter 1 Company Name <br />I <br />6. <br />US EPA ID Number <br />A. State Transporter's IDC <br />--- <br />7. Transporter 2 Company Name <br />AA <br />6C /T <br />8. <br />USE A ID Number <br />B. Transporter 1 Phone <br />I <br />T <br />C. State Transporter's I <br />Signature <br />9. Designated Facility Name and Site Address <br />l ="c <br />,Ev ii i ai�`A <br />10. <br />US EPA ID Number <br />P. Tmspofter 2 Phone <br />E. State Facility's ID <br />4i <br />is Y& C-51 hti! � <br />Month <br />Day <br />cp o <br />F <br />C <br />McF.u�c�''dr Q -�,� <br />c� <br />�1�75� <br />F. Facility's Phone <br />75'x= OO <br />A <br />11. WASTE DESCRIPTION <br />12. Contain 13. <br />14. <br />aA1011p <br />) <br />No. <br />Total <br />Type Quantity <br />Unit <br />Wt./Vol. <br />Tv 1nj V ii^ <br />20. Facility Owner or Operator: Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br />gin <br />b. <br />Printed/Typed Name Signatu <br />Month <br />Date <br />Day <br />Year <br />C. <br />0,2 <br />o <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />_ _ <br />H. Handling Codes for Wastes Listed Above <br />1/A )4134;, <br />- - ---- <br />15. Special Handlinq Instructions and Additional Infnrmatinn <br />16. GENERATOR'S CERTIFICATION: I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br />in proper condition for transport. The materials described on this manifest are not subject to federal hazardous waste regulations. <br />Pnntedrr?r Name Signature <br />✓ t` 1-i ls <br />Month <br />Date <br />Day <br />Y ar <br />��3 <br />O <br />G <br />RT <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />N <br />S <br />Name Signature <br />/ �� <br />:;4� <br />Month <br />Date <br />Day <br />Year <br />P <br />v _. <br />f� <br />pR <br />18.Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />Printedlf YPed Name <br />Signature <br />Date <br />E <br />R <br />Month <br />Day <br />Year <br />F <br />19. Discrepancy Indication Space <br />A <br />C <br />1 <br />L <br />20. Facility Owner or Operator: Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br />I <br />T <br />Y <br />Printed/Typed Name Signatu <br />Month <br />Date <br />Day <br />Year <br />0,2 <br />o <br />