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WHITE —ORIGINAL (Return to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />NON-HAZARDOUS1. <br />GeneratoPa U$ EPA ID No. <br />2, Page 1 <br />3. Document Number <br />WASTE MANIFEST <br />of <br />No. 10290 <br />1 <br />4. Generator's Name and Mailing Address <br />Generator's Phone <br />S. Transporter Company Name B. US EPA ID Number <br />7. Tranaporter Phone <br />8. Designated Facility Name and Site Address B. US EPA ID Number <br />10. Facility's Phone <br />13 <br />E <br />N <br />11. Waste Shipping Name and Descrlpllon <br />12. Containers <br />13- <br />14, <br />E <br />No. <br />Total <br />Unit <br />VAftl <br />T <br />Non-Hazardous waste, Ilquld <br />0 <br />15, Special Handling InstnrcUona and Additional Information <br />Handling Codes for Wastes Listed Above <br />111a. 111b. <br />i< <br />CENLU <br />SEP 19 2014 <br />_yl1•i tot J, �' v.l !, i 'i -(QhjjA: f. �. <br />r <br />18. GENERATOR'S CERTIFICATION: I certify the materials desorlbed above on this manifest are not subject to state or federal r6guillicqi orhllg proper disposal of Hamrenus Waste. <br />Prinlacirfyped Name Signature <br />T <br />A <br />Month Dsy Year <br />A <br />V <br />S <br />1T T nsoorter c wt—dd.—r ­0 of fiVelpiof ter[als <br />GrintadtTyde!! <br />{ria 1 t. LVJ r } <br />j Slgfia ;,. • i t, r: <br />T <br />Month Day rear <br />F <br />A <br />C <br />I <br />L <br />' <br />I <br />T <br />Y <br />19. Fa ill Owner or Operator: Certlnoatlon of recelpt of waste materials covarod by this manilast excepl as noted in Item 18. <br />PrinumiT rped Name <br />Signature <br />Month Gay Year <br />WHITE —ORIGINAL (Return to Generator) YELLOW —TSDF (Retain Copy) PINK —TRANSPORTER COPY GOLDENROD —GENERATOR'S COPY <br />