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/ �k IIII <br /> NON-HAZARDOUS I. Genorefor't US VA ID No. Manifest !} 2. Pope 1 <br /> WASTE MANIFEST '''1r '4-03-t N4.� of ,� <br /> 3, Grencrator's Nam*and Mo;1In Ad r " T' ;''�' 'f`i' •? :• Y .,-�•r ,� <br /> g dais f.T I" .r 'iA....rt'_, rnCTTI'"C,�... <br /> d, Genrrolar's Fhena f ) �^;sr�! �"J'� !+(�•�� i'� p <br /> 9. Tromperlor I Camoony Namv J r 6, US EPA 10 Nvmbar <br /> 7 Transportor 2 Company Nalna B, LS EPA ID Numbor j <br /> 9;.4esignolod FcciHij Name and Sifc Addrrss 10, US VA ID Numbar Ij A, Tranyporfer's Phone <br /> i <br /> $�'i'�� li B. Trumporlrr's Phone <br /> 2717 C. Facil;ty't Phan* <br /> T?TC'#l�7�?s <br /> 11, Waste Shipping Norio and CoScr;Urian I' 12. Confoinan 13. 14, <br /> ? r o. <br /> Tofal i Unit } <br /> 0 r�r�l? T1rldwf•.J,.I.,h✓'.1 ..'4�:r•' "� I I <br /> N <br /> w A <br /> T f <br /> i <br /> D. Additional Colvipfitm for Mwcriols Lk.led Abo�o E, Handling Codcs Jor Woslos Good Abava II <br /> Y�t�_r ir.l�:J �';�`�r.i'S�';T''.��t"r'.{� 1�Z'.('?� ��V'i�•,'��•tt�,�,•';,,� i ( 1 <br /> 15. 5poeiol Handling Instrvctions and Addilignol Irliwroflon ! „� <br /> ,T$!I 1k:, 2.111`X71", 's�i�1;�:� I �1r��t�iti.J"'.t Cit R�inl` <br /> If <br /> xTj T;i :t7 ::� ��:i:y`r�r,T;l "7 '1i;'41 iA • E <br /> �6 <br /> 16.GENERATOR'S CERTIFICATION; I v.v;sv dic mvlor;ck dV%v:bed C�_o.o on This moniicsg are rol ,ubien to I.ide+e{ iag0wiorn for r5porllni; praoer 3lrpmaf of ka:ardovt µ'el+e. <br /> Drintud/YYPnd Nor,te�- Signorvra Mon+ll flay Ye or <br /> J i 1 L1 <br />{ T 117,Transporter I Ac4notiiedgrment of Rotc:cf of Maferiats <br /> A Frintad/Typed Norse r .� j Sig naturek Mang Day, <br /> Qit;,Tcamourler 2 ACknowlodgomanl of Rrccipi of Moloriols <br /> T Prinled/Typod Noms I SignQiura Mon+h Ccy Yper <br /> 4A I <br /> 19,piscrcPaney Indication 5paca ;i <br /> C L <br /> c0.Focilify Ownor or Corrotor:Certilicilion of roc:ipf of wosla mvtcri;Is.overed by this manifest e>ceps as noted in Itcm 19. <br /> 1 � _ <br /> T 'k <br /> Y Printed/T ped Nam* h Sigr,of `/� Ir Menfh Dqy year <br /> ur <br />