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NON -HAZARDOUS WASTE MANIFEST <br />Please print or type (Form desiqned for use on elite (12 pitch) tvoewriterl <br />CF14 Q 2002 LABELMASTER® (800) 621-5808 www.labelmaster.com <br />®P PiMEIt� 50 06.w vMPw6x <br />us' _1SOVINK <br />NON-HAZARDOUS-GereiatoKsUSEPAIDNo. <br />!! <br />Manifest <br />2. Page' <br />WASTE MANIFEST <br />Document No. + <br />of <br />3. Generator's Name and Mliljng Address <br />r, 1. ♦. .r'il <br />l r <br />4. Generator's Phone ( ) <br />5. Trapsporter 1. CompanyrName . ; 6. <br />US EPA Ip Number <br />A State Transporter's ID <br />B. Transporter I Phone <br />7. Transporter 2 Company Name B. <br />US EPA ID Number <br />C. State Transporter's ID <br />0 Transporter 2 Phone <br />9.ippaigoated.Facility Name and Site Address 10. <br />US EPA ID Number <br />E. Stale Facility's ID <br />F. Facility's Phone <br />11. WASTE DESCRIPTION <br />Containers 13 <br />14 <br />Total <br />Unit <br />No, <br />Type Quantity <br />Wt./Vol, <br />;y, iii'•.ti31...:i4'•'i'•.i�f�i';r.1` ;t1�1; ?{.': t <br />. <br />G <br />E <br />b <br />— <br />N <br />E <br />A <br />G 208 <br />MAy <br />R <br />d. <br />N;JiEN <br />ENV�R ��a�TM�N� <br />VAT --- <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />I S. Special Handling Instructions and Additional Information <br />icrp f+!-i�.r.�'ur $'± ";9 't►f'[;: uI <br />'-yr <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 />Date <br />Printed/Typed Name <br />Signature <br />Month <br />Day Year <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />A <br />Printed/Typed Name <br />Signature <br />Month <br />Day Year <br />N <br />S <br />P <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />Printed(Typed Name <br />Signature <br />Month <br />Day Year <br />E <br />R <br />F <br />19. Discrepancy Indication Space <br />4 <br />20. Facility Owner or Operator: Certification of receipt of the waste materials covered by this manifest, except as noted in item 19. <br />L <br />Date <br />T <br />Printed/TypedName <br />Signature <br />Month <br />Day Year <br />Y <br />CF14 Q 2002 LABELMASTER® (800) 621-5808 www.labelmaster.com <br />®P PiMEIt� 50 06.w vMPw6x <br />us' _1SOVINK <br />