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,.. : � �. � - : .•: -�- NO�.��ZQRD4US..WASTE ;MANN--�� -� <br /> • : <br /> Piease'print or type :: (Form designed for.use on elite(12 pitch typewriter} - .,Manifest - 2.'Page i <br /> 1.Ganerator's US EPA.iD No 'Document No. <br /> NON-HAZAR©SUS: c� ., . 2 5 3 a5 :. � of <br /> WASTE MANIFEST.. .::= . <br /> 3.Generator's Name and Maiiing;Addmss - <br /> tUa �i L <br /> PaL trt7 1Z? ? <br /> 4.Generalofs Phone I .�. '. ':.. °7=� 51.1') - <br /> 5 Transporter 1 Company Name. tl. US EPA ID Number A.State TransporteLs ID: <br /> y.Mt- ta- �' {) }�? B.Transporter 1 Phone 4, — r ? <br /> 7 Transporter 2 Company Name US <br /> -PA ID Number ' . C.State Transportefs ID <br /> r <br /> ansporter 2 Phone <br /> 7. <br /> .9,Designated Facility Name and Site Address 70:' US EPA iD Number - _ ale Fatilifys4. ctilltys Phone <br /> _ 12. Containers 13 .-..74. . <br /> --_1 t:1MASTEDESCRIPTION. - - _ - Total' - Unit - <br /> f Ou'antiry <br /> _ - - :Na Type .VJtNoL'- <br /> 'a..- - - - <br /> f7 C'T'S' T <br /> b. <br /> _ - <br /> N. <br /> E <br /> A a <br /> p: <br /> G-Additions{Descnphons far Materials listed Above _ • - - :H.Handling Codes for Wastes Listed Abova <br /> C ! =1Ud1=�lc�'�..cifl . fit j <br /> Y <br /> T,. C <br /> -A 5 Special Handling Instructions and Add'Whal Informalory J - <br /> J. <br /> -.:-- . .. <br /> i 0° S pct. Zint <br /> "�-99 0 I�C,'.�ali.R <br /> qt <br /> ifi:GEIiERA7pq(S CERTIFICATION:I hereby ceitify that the;contents of this shipment are foliY,arid accuiaialydescribed andate in a8 respects - <br /> .[n proper eonditiori 9or transport.The materials described on this manifest are not subject to federal hazardous waste regalallons <br /> :Data <br /> PrintedlTyped Name - a Siry}aw Monffr. .Day Yea <br /> V.-Transporter 1 Acknowtedpmeritof HeceipiofMateaals' - <br /> R, <br /> y d Name Signature Mo fi %Day :Ye <br /> P <br /> e <br /> •0 - -16..Transporter 2 Aoknowledgemenl of Receiptof,Matanats'- r., ,; <br /> Oate <br /> PnntedTypedName <br /> Signature �Y <br /> E'' Month iOar <br /> F <br /> :. 79:Disc[epancy�Jrndication Space.,L <br /> F.. -------------- <br /> :A, <br /> G. <br /> 20.Facility Owner or Gperalor,,Cerhticalion'of receipt or.lhe waste materials covered 6y this manifest,except as noted in item 79 - <br /> L <br /> +_ <br /> win-tad(fyped Name .S+gnalure Month _Day .Year <br /> Y <br /> F-.14 0.20M, --F..AQF�.MASTF,Re[BOD)821�+808 wWwlebelm6tterCori! -PratrnE6tlNREG�'pF.OPAPER_' HeV.3/95 <br /> 0> <br /> usn+csoraF�wlryt - : .INK - - <br />