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`r . <br />Sr, <br />N <br />D <br />O <br />/a <br />1.i <br />Q <br />N <br />Q <br />Z <br />Z <br />NON -HAZARDOUS WASTE MANIFEST <br />Please print or type (Form designed for use on elite (12 pitch) typewriter) <br />CF14 Gc 2002 LABELNIASTER® (800) 621-5808 www.labelmaster.com <br />®� WiENOry NECYClEO WEEN <br />uaxO50reF/Jl w, .'isey lNK���. <br />NON -HAZARDOUS <br />'s US EPA ID No. <br />Manifest <br />2. Page 1 <br />WASTE MANIFEST <br />Document No. i %. i <br />of <br />3. Generator's Name and Mailing Address <br />a. Generators Phone ( ) <br />5. 1 rpsporter 1 Company Narne I k' <br />o. US EPA ID Nurpber; „ ,., . r , , <br />A. State Transporter's ID <br />B. Transporter 1 Phone <br />7. Transporter 2 Company Name <br />8, US EPA ID Number <br />C. State Transporters 10 <br />D Transporter Phone <br />'led �Facilil� NaT,and Site Addfgss <br />10. US EPA 10 Number <br />E. State Facility's ID <br />y <br />F. Facility's Phone <br />11. WASTE DESCRIPTION <br />Containers <br />13. <br />14. <br />_ <br />Total <br />Unit <br />No. <br />Type <br />Quantity <br />Wt./Vol, <br />E <br />b. <br />RE-CEIVED <br />N <br />E <br />R <br />` <br />MAY 10 2018 <br />T <br />R <br />d <br />EN <br />PI r_ n I TH DEPA!9PAENT <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling Instructions and Additional Information <br />';,a" k. 'z-.'; : J rs. a �', ,: �[a ?� / �,t u ''b_,ri;,R=� C�S�`'� rt •{Yrr'j�y° -Y' _ <br />-� <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 />Pdntedrryped Name <br />Signature <br />Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />R <br />A <br />Pdnled/Typed Name <br />Signature <br />Month Day Year <br />N <br />S <br />P <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />H <br />T <br />Printedrryped Name <br />Signature <br />Month Day Year <br />E <br />R <br />F <br />19. Discrepancy Indication Space <br />' <br />4 <br />L20. <br />Facility Owner or Operator: Certification of receipt of the waste materials <br />covered by this manifest, except as noted in item 19. <br />Date <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />CF14 Gc 2002 LABELNIASTER® (800) 621-5808 www.labelmaster.com <br />®� WiENOry NECYClEO WEEN <br />uaxO50reF/Jl w, .'isey lNK���. <br />