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Pirelli pr IX J f <br /> "rest <br /> NOW-HAZARDOUSGenerator's US EPA ID No. 2. Po <br /> WASTE MANIFESTr. men, <br /> 3. Generator's No..and Moiling Address"T—.. <br /> 1-M <br /> 4. Generator's Phone( <br /> 5. Transporter I Company Name 6. US EPA 10 Number <br /> ,N;,71:T <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> . . . . . . . . . . . <br /> 9- DOS, noted Facility Name endSit,Address 10. US EPA IDNumber A. T,amponer',Ph... <br /> *l., „ INC_ <br /> )P3 5 8. Tronsponer%Phone <br /> TFacilify's Phone <br /> I I- Waste Shipping Name and Description 12. Costs umm, 13. 14. <br /> Npe Total Unit <br /> No. Ty <br /> Ourintity Wit Vol <br /> It. <br /> C. <br /> 0 <br /> R <br /> d. <br /> D. Additional Descriptions for Materials Usited Above <br /> E. Handling Codes for Wastes Listed Above <br /> 13175 <br /> 1)3 <br /> 15. Special Handling Instructions and Additional Information <br /> 16.GENERATOR'S CERTIFICATION: I centy ine maranals deaabad aoo.e on his reanifir,are W bit,, so fiesta "vienom fit, redone, nittrif dufiiii, of d.d,,xu <br /> Printed/Typed Name Signature hismil, Do, Y., <br /> 17.Transporter I Acknowledgement of Receipt of Materials <br /> Printed/Typed Name <br /> Signature miseth Day <br /> Y!W <br /> R 18.Transporter 2 Acknowledgement of Receipt at materials <br /> T Printard/Typed Nam. Signature <br /> E Menih ow Year <br /> 19.Discrepancy indication Space <br /> F <br /> 20.Facility Own.,or operator:Certification of receipt of waste materials covered by This manifest except as noted in Ihnn 19. <br /> Printed/Typed.Nome Signature M­,h 0., Year <br /> T/S/D/F COPY <br />