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NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite(12 pitch)lypewrilar) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> Document No. <br /> WASTE MANIFEST - ( �t_ d�}k of <br /> 3.Generator's Name and Mailing Address EN vc,,,n l��t 1 1 Cj 1� ( p, <br /> AL <br /> 4.Generator's Phone( <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporters ID <br /> i a,f• rjj B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Q"nalad Facilily Name and Silo Address 10. US EPA ID Number E.State Facility's ID <br /> f 1✓offll"� Y o F.Facility's Phone <br /> '40-11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt./Vd; <br /> a. <br /> G b. <br /> E <br /> N <br /> E <br /> R C. <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> H <br /> N <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> U) <br /> n <br /> 0 <br /> 0 <br /> Q <br /> N <br /> 15.Special Handling Instructions and Additional Information <br /> Z <br /> 0 <br /> Z <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 Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A Prinledlryped Name Signature <br /> N _ / / Month Day Year <br /> p 18.Transporter 2 Acknowledgement of Receipt of Materials — Date <br /> RPrinted/Typed Name Signature T 9 Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 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 Prinled(Typed jJame J t Signature Month Day t Year <br /> F-14 02002 LABELMASTER® (800)621-5808 www.labelmaster.com uu�rr Rev.gig$ <br /> SOYINK_ <br />