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s <br /> .al- <br /> NON-HAZARDOUS 1. Generator's U$EPA ID No. manifest 2. Page 1 <br /> WASTE MANIFEST G, -1 • .n• 0• r]• '� 6• 0cumeer M of <br /> Generator's Nome and Marling Address <br /> I4I'll �'4Lr.rbon LA ir- lob <br /> 4. Generator's Phone( L,0 g ) 16 4 <br /> _ 1 1 <br /> S. Transporter I Company Nome 6. US EPA ID Number <br /> Male eta So GAL 0. 0-0-0- :Z-7- 7 .6. <br /> 7. Tronsponer 2 Company Nome r 8. US EPA ID Number <br /> 9: Designated F�1acility Name and Site Address 10. US EPA ID Number A. Transporter s Phone 31 _ <br /> FOrLX,rG Ley. JA II r I^& B. Transporter's Phone _ <br /> r1'� ,aes•n Atit!�/� �04 a C. Facility's Phone <br /> Mc.nlcc5 G0. > > 336IC-A.D•4-'-J•7- '.4. . Z— Zq <br /> I1. Waste Shipping Name and Description 12. Containers 17. I4• <br /> Total Unit <br /> NO. File Ouismi Wt Vol <br /> a. Waste. solid <br /> r <br /> G It. <br /> c <br /> A <br /> C. <br /> T <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> ?MK 130S 03 <br /> 15. Special Handling Instrucrions and Additional Information <br /> N/A <br /> 16.GENERATOR'S CERTIFICATION: I .rely the manriah described above on Mit aaalee an ran sabjea to lederd legabtlons for retsamng paper disposal of Haeardoas Wass.. <br /> .y Pnmild/Typed Name Signature j" �r rn Month Doy Year <br /> 4 <br /> T 17.Transporter I Acknowledgement of Receipt of Materials ./ <br /> 4 <br /> Printed/Typed Name Signature Mantra Day Year <br /> J <br /> 0 118.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name <br /> Signature Manrn Dar Year <br /> E <br /> R <br /> 19,Discrepancy Indication Space <br /> F <br /> A s <br /> 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/Typed Name Signature Miami, OaY Year <br /> GENERATOR'S COPY <br />