Laserfiche WebLink
NG. - ,HAZARDOUS WASTE MANS. IST <br /> Please print or type (Form designed for use on elite(12 pdch)typewriter) <br /> Manifest Z.Page I <br /> 1.Generator's US EPA 10 No. Document NO. <br /> NON-HAZARDOUS Of <br /> WASTE MANIFEST <br /> 3.Generators Name and Mailing Address <br /> 4,Generator's Phone <br /> 5.Transporter I Company Name <br /> US EPA ID Number A.State 7ran$Pcrtcrs ID <br /> B.Transporter I Phcn <br /> 12- L .. . <br /> Trrl, . ....... C.State Transporters 10 <br /> 7.Transporter 2 Company Name US EPA ID Number <br /> D.Transporter 2 Phone <br /> 10, US EPA to Number E.State Facility's ID <br /> 9,Designated Facility Name and Site Address <br /> L <br /> F.Facility's Phone <br /> -71 J 7 <br /> 14. <br /> 12. Containers Total Unit <br /> 11.WASTE DESCRIPTION Wt.Nol. <br /> No. Type Quantity <br /> a. <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> 0 d. <br /> H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials-Listed Above - <br /> "713 iYlr <br /> PIT r 7J,7 <br /> 15.Special Handling instructions and Additional Information J d <br /> 4L 4 <br /> -J <br /> It'll <br /> 16,GENERATOR'S CERTIFICATION:I hereby certify that the conterils 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 /> PrinledlTyped Narne'r. Signature.; Month Day Year. <br /> Date <br /> a <br /> T 17.Transporter I Acknowledgement of Receipt of Materials <br /> Signature "'2_ Month bay Year <br /> R <br /> A Prinledii`Typed Name <br /> V1 <br /> Date <br /> P18.Transporter 2 Acknowledgement of Receipt of Materials y Year 0 Signature Month <br /> R <br /> T Prinledrryped Name <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, Date <br /> L <br /> I Signature Month 7Day Year <br /> T Printecirryped Name <br /> Y <br />