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Nt,.J-HAZARDOUS WASTE MAN =EST <br />EES20 <br />NON -HAZARDOUS <br />11. Generators US EPA ID No. <br />Document No. NH 4 5 2 7 Manifest2 <br />Page 1 <br />WASTE MANIFEST <br />of 1 <br />I 13. <br />Generator's Name and Mailing Address 4 <br />5-741 <br />4. Generators Phone (Zal zJ-- -IrcAc C 3 L V <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />A. Stale Transporters ID C JJ <br />113 (r <br />B. Transporter 1 Phone <br />7. Transporter 2 Company Name B. USE A ID Number <br />C. Stale Transporters I <br />D. Transporter 2 Phone <br />I <br />I <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />/`e-e,I>`t1(/ �'�i//c <br />E. Slate Facility's ID <br />1 <br />/rvej—,J' <br />rp 99 CO S h'1./ Q'T7, 4✓ e, <br />cm) p <br />F. Facility's Phone <br />McLc,04,ii~x cc., 4 a 1 c Y 179 <br />v 79 , v0 <br />111. <br />WASTE DESCRIPTION <br />12. Contain s <br />13. <br />14. <br />Total <br />Unit <br />No. Type <br />Quantity <br />Wt.Nol. <br />�,��. (' <br />Al <br />G <br />b. <br />E <br />N <br />E <br />R <br />c. <br />A <br />T <br />O <br />R <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />IIA) /405 <br />15. Special Handling Instructions and Additional Information <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 />n proper condition for transport. The materials described on this manifest are not subject to federal hazardous waste regulations. <br />Date <br />Printed/T d Name <br />�. I f--1 D, Lpw <br />Signature <br />Month Da Y�z <br />0 Z G y <br />TR <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />A <br />P <br />Printed///Ty ad Name // c <br />`G Q <br />Signature <br />Month Day /Yez <br />d ` L <br />Q <br />18. Transporter 2 Acknowledgement of Receipt of Materials ` <br />Date <br />R <br />T <br />Printed/Typgd Name <br />Signature <br />Month Day Yep <br />E <br />R <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 />Date <br />T <br />Y <br />Printed/Typed Name <br />� TC'r-� �� <br />Signatu <br />Month Day Ye: <br />0.21051 /o <br />