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to use tr -elite(' 4'-1: `/ __...._.-____. .. ... <br /> I �.: r@©h N.4ZARUOUS, <br /> i.Seneretor lD lJunibei or T r -r rai r none �e Was€s".ractrt7tan :.c. <br /> 3( 1 E FVAfTE INANlFEST F i ' - <br /> j k f 5 Generator's Name and Mailing Address Geo_ratei's Site Address(if different Bean mailing address) <br /> V <br /> Ganerad,' Phonc <br /> I E.Transporter 1 Company Name U.S.EPA ID Number <br /> v.Tram porter 2 Company Name <br /> U.S.EPA ID Number <br /> e <br /> 8.Designated Facility Name and.Site Address F, n U.S.EPA IDNumher <br /> li yr <br /> faculty's Phone: ` <br /> 9a. <br /> 9b.U.S.DOT Description including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group('rf any)) No. Type Quantity WLNoI. <br /> 0 i, <br /> a4 <br /> Z 2 <br /> w <br /> (7 <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional Information <br /> #00114 07,�'FNT lyciN-t-k91'TY FPjf*4yy. <br /> 14. GENERATOR'S CERTIFICATION: Icertify the materials described above an this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Generatoes0fteners PnntedfTyped Name _ Signature, Month Day Year <br /> 15.International ShipmentsL1i— Impon to U.S. ❑Export from U.S. 'Port of entrylex`it <br /> Z Transporter signature(for exports only: Date leaving U.S.: <br /> W <br /> 16.TransporterAcknowiedgment of Receipt of Materials <br /> � Transporter 1 P[intedRypetl Name {-_`)f>� Signature a � Month Day Year <br /> QTransporter2lormtedrityped NameSignature Month 'Day <br /> F <br /> 17.Discrepancy <br /> Its,Discrepancy Indication Space ❑ quantity Type Residue, Partial Rejection Full Re <br /> ecdon <br /> Manifest Reference Number: <br /> ti 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> w. 17c Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> C7 <br /> W <br /> �.F11.Designated Facility Owner or Operator:Certification of receipt of materials severed by the manifest except as noted in Item 17a <br /> itedByped Name Signature Month Day Year <br /> 6-NHM-C-C-11 <br /> 6-GENERATOR'S INITIAL COPY <br />