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NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. <br /> Document No. <br /> WASTE MANIFEST <br /> 3. Generator's Name and Mailing Address <br /> ot <br /> a. Genera <br /> S. TransposerI Company Nome 6. US EPA ID Number <br /> 7. T,orisporter 2 Company No., S. US EPA ID Numb <br /> er <br /> 9: D <br /> Page <br /> g <br /> "is I <br /> 4;Pnoted Facility Name and Site Address 10. US EPA ID Number A. Transporter's Phone <br /> all <br /> z,v a <br /> T-)QS a. Transpomer's Phone <br /> C. Facility's Phone <br /> .-,-y <br /> �W_wlcx"sl i n <br /> 11. Woos Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> Type Guano Wt Val <br /> a. <br /> G It. <br /> E <br /> N <br /> E <br /> T <br /> D <br /> R <br /> d. <br /> D. Additional Descriptions for materials Usted Above <br /> E. handling Codes for Waste,Listed Above <br /> `1W 1305 <br /> ,13 <br /> IS. Special/Handling Instructions and Additional Information <br /> .4 <br /> I <br /> 16.GENERATOR'S CERTIFICATION: I ximb, ibe ximoveis dinimbed aoi,wt v, ibis x"mi's" on not vubliris ro federal Issui,nime for inomn a ....o di,ousal of Harami., Wam... <br /> Printed/Typed Name Signature <br /> . Month Day Year <br /> T 17.Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature <br /> N VIcash Day Yew <br /> S <br /> p <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name <br /> E Signature Mouth Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> 1 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in item 19. <br /> T <br /> y <br /> Printed N Aignature Month Day year <br /> T/S/D/F COPY <br />