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. N �HAZARDQUS WASTE MA�t„ ST, . <br /> Please print or type`` (Form designed for use on'elite{12 pitch)typewriter) - _ 'Manilesl ''�_��L].. - . 2'Page 1 <br /> NON-HA ARD4US 1.Generators US EPA ID No Daurnent Nq: <br /> of <br /> _ .WASTE MANIFEST <br /> Generators Name and Mailing Address <br /> : t r1�1tx. i� <br /> 1 �•. mfr <br /> -040 <br /> C2 <br /> 5� } .f^� ll i Lt►. _.G .�lTtf C� ' . <br /> 9 .. <br /> -4 Generators Phone( 7. — �, - - <br /> 17 <br /> 5 7ransperter t Company Name .. 6. .'US EPA ID Number A.Stats Transporters ID <br /> '•a; ''9.Transpertert.Phone' ,`(. "g—A r• <br /> .Z-Transporter 2 Company Nara, .B. US EPA ID Number G.State Transporters ID - <br /> D Transporter 2 Phone <br /> 9 Designated Facility Name.and S'�te Address .10. US EPA ID Number' E.State Fadili. s t. - <br /> Z Facility's'Phone+ <br /> „�riter3 :Stzeet <br /> �. : -. <br /> _ .12. 'Containers. 13. '14: <br /> 11. Unit <br /> WASTE DESCRIPTION. .' , i .. - <br /> .- uentity .'` WL/Vol. <br /> .T <br /> -7-777771 <br /> a <br /> :. <br /> G e. <br /> E <br /> ° _ <br /> E <br /> RC.- <br /> A. <br /> 77 <br /> ,R. <br /> G Addnional Descripticnsicr.Materials Listed Above - �.•tvl Handling Codes for Wastes Listed Above; e <br /> a.) OF <br /> cx `rater- i " f1 ` <br /> U N <br /> 15 Specia!Handling Instruchbns and Additional Information .��>:)1 ,Sjt Std--ktOa -15'a -, - <br /> % <br /> Rd <br /> "Stock <br /> �"�7 <br /> M. <br /> MAN <br /> .1&.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are full end accutatery describetl and acs in all respects <br /> ia'propef condition for transportr,The rr*tenals described on this-manifest are not'subject to fedefal hazardous waste regalaSlons _ <br /> Pf ntedlfyped Name % <br /> Sign 1 Day YearData <br /> T•. i7_,Transported•Acknowledgemeruof Recelplof Malertals _ <br /> R Sign�fLr Month Day Year , <br /> q Pri 1 yped Name y - <br /> S. - � <br /> P , ; Date <br /> 10.Transporter 2 Ack_no dgement of <br /> Receipt o1 Materials - <br /> RT. PrintedlTyped,,Narrie ,Signature - 'Month. Pay - -Year <br /> R <br /> F <br /> 9'Dlscrepancy Indication Space <br /> A <br /> 20 Facility Owner or Operafaf Cerhfivaaon of receipt of the waste materials covered by this mamlest except is m+rem 19 ' <br /> L FT <br /> Date <br /> Day <br /> y <br /> -'�; Pr+nledlTypedNameSlgnature- Mortih ear <br />