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WHITE—ORIGINAL (Retui to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />FH <br />NON -HAZARDOUS <br />T, Generator's U8 EPA ID No. <br />2, Pepe 1 <br />3. Document Number <br />WASTE MANIFEST <br />of 1 <br />NO. 10,290 <br />4. (3enerator's Name and Malfing Addrosa <br />RECEIVE[ <br />Generator's Phone <br />JUL 2 8 2014 <br />5. Transporter Company Name B. US EPA ID Number <br />7. Transporter Phone <br />:•' ( - ;.. I t. <br />ENVIRONMENTAL HEA <br />DEPARTMENT <br />B. Designalad Facility Name and Site Address B. US EPA ID Number <br />M Facility's Phone <br />0 <br />E <br />N <br />11. Waste Shipping Name and Description <br />12. Cantalners <br />13. <br />14, <br />E <br />No. Tipe <br />Total <br />nijly <br />Unit <br />WVV0l <br />R <br />a. <br />T <br />Non -Hazardous waste, liquld <br />o <br />_ <br />15. Special Handling Instnir-tona and Additional Information <br />Handling Codes for Wastes Usled Above <br />11 a. 11 b, <br />18. GENERATOR'S CERTIFICATION. I certify Ase materials descrlbed above on Ihis manifest are not subject to stale or federal regulations for reporting proper disposal of Hazardous Wasta. <br />Printad?yped Name Signature <br />T <br />R <br />Manth Day Year <br />A <br />$ <br />11. T—nsponer wled e e of I 1 Dt rfala <br />P <br />a <br />rintadl Wah Itie LTJ �' { } <br />Slgha <br />F1 <br />T <br />Month Day Year <br />16. r�rfc�jlndica Hca° w_�. -� �\y )--•�--j l—� 1.;..,a: �__�.c� ��.. J <br />F <br />A <br />C <br />I <br />L <br />I <br />T <br />y <br />19. Fadll Owner or Operator. Certification of receipt of waste materials covered by this manifest except as noted In Item 18. <br />Prinuxirr rped Name <br />Signature <br />Month Day Year <br />WHITE—ORIGINAL (Retui to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />FH <br />