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NOARD.OU <br /> S WASTE-MANI ' <br />'release Pent or type (Form designed for Useorelite(12 Pitch)tyPevniter) - - - - 2.Page 11 <br /> _ Manifest - _ - _ <br /> NON'HAZARDOUS t.Generators US'EPAiD No. Document No. V113.' pf <br /> WASTE MANIFEST ?��, <br /> 3.Generalbes Name and Marlinx Address-'. <br /> a. <br /> JF <br /> .5200 <br /> -4.Generate(sPhone(-- -.,120 2;54-5a!00 <br /> US EPA ID Number A.State Transportefs ID' <br /> 5:Transporter,Company Name I - �j• ti�g� -537 <br /> -,r ,.. NT '�'ikF �'�7 3;)f) B.TransPorter i Phone <br /> 5'1C. <br /> 7.Transporter 2 Company Name' :US,HPA ID Number C.Stale Transporters fb <br /> D.Transporter 2 Phone <br /> ' t <br /> to. US EPA ID Number <br /> 9.Designated Facility Name and Site Address J. <br /> E.S to Facility's Ib - <br /> �a dy ,"�gv,_t"JT+':S1ep .moi F:Facility's Phone , <br /> r�73=7.�i t o 0 '200 � r} <br /> : 73IE1.s3 ��• 12. Containers 14. <br /> Total <br /> Unit; <br /> 11.WASTE DESCRIPTION No. 'TY� 'Ouantity W1jvcl..' ' <br /> l.. <br /> G. b• <br /> R: c. <br /> O <br /> _ . H:Handling Gode or Wastes <br /> ".G.Additional DescriptListed Abe <br /> ions.for Material's Listed Above: <br /> PROETLT3 Of) <br /> h ? fl✓ <br /> ' 15.SpecialHandlinglnstructionsandAdtlihona{Information .J'r�l .c� Lcs•' S{;,' ,}'�', rr`��3- x. <br /> ;ii��%�y;�tt-++ 99. �. , �- • 921 S <br /> 61 7 <br /> 904 4 <br /> 15'G pNERAconditionOEor hanspartoThe ma®brlati edescribed on his mantles are Tt0y.ffiat I'lue of this of subject to,9de ment areal hazard us wa to gulat onsn all respects <br /> .. <br /> ...Dale <br /> Signet Month .Day_ Year <br /> PrintedlTyped Name RJ��'jj 33 <br /> t..r <br /> 17,Transporter l'AcknoM6dgement of Receipt of Matenals - Mon Da 'Ya <br /> signatui <br /> Name <br /> Pri d V - <br /> r� f . <br /> fl <br /> Jt� <br /> g i <br /> PMaterials <br /> cei <br /> t of <br /> ' at at Re r. <br /> .. 2 Ackno -.19-Me P ' Yea <br /> rter - - -Da <br /> iB:Transpa - ... � Month y . �. _ <br /> R Printed/Typed Name <br /> Signature ' <br /> T. <br /> R <br /> 19.Discrepancy indication Space - - - <br /> 2D.Facility Owner.or Operator;GerUtcalion of receipt of the waste materials covered by this manrfet except as noted m item 19-- - -gate <br /> Y. <br /> Signalure Month': Day ;Yaer <br /> 1 <br /> -pnntedfTyped Name- <br /> ' Y <br /> - '-: -Rev 3145 - <br /> .. <br /> F.'14'02.002""lJ1SFL�"'�ASfFR ilk( t�621 aB08 IVWMr.kSbBIm0,11er.GO.n PRkf1Ee ON ISECYOtfO FMER a m wn - .. <br /> �.x ore�wwrt" SOYINK <br />