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+WprlPl j .DIY{ f \ <br /> i.i <br /> NON-HAZARDOUS 1. Generator s US EPA 10 No. Manifest 2. Page I <br /> WASTE MANIFEST ^, t ":' n. ¢• ?. ;. �. ,. rD°`�m4'"'.p of <br /> I Generator's Name and Moiling Address <br /> MLa,i• •.. u. Jl� <br /> wJA <br /> 4. Generator's Phone( 11S -s(J?^, C12 <br /> 5. Transports+ 1 Company Name 6. US EPA ID Number <br /> rxv- `.'Y 'slits .7_'r.`a ..'T: -, !+ 7. r. <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 9: Designated Facility Name and Site Address 10. US EPA ID Number A. Tramparter's Phan. <br /> 1�- VMr'Tei s w�iy 3�••c. <br /> 3S9i7'^i <br /> 8. Transporters Phone <br /> .> i T '1yj <br /> C. Facility's Phone <br /> ='rA`,^t_3.•1 ^_1 9 �R f. 3. n '1. ^. :y. . p. R. .7 •'.'S� GA^ <br /> 11. Waste Shipping Name and Description 12. Cons man 19. 14. <br /> Total Unit <br /> Na. TYPe Ouonn Wt/vel <br /> a. <br /> `TlI 117 AC-=, <br /> G <br /> Is. <br /> E <br /> c <br /> T <br /> O <br /> 1 <br /> d. <br /> 0. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 13D, <br /> 03 <br /> 15. Special Handling Instructions and Additional Information <br /> y/A <br /> 16.GENERATOR'S CERTIRCATION: I comty IN. matedWs described ab.. en do. momfsp are nor wtsw to federal reguienter,fer r.,omng proper ahposal of Hazardous Was.. <br /> Printed/Typed Name Signature Monte Ooy yearri <br /> N 17.Transporter I Acknowladgemant of Receipt of Materials <br /> 1 Printed/Ty ad Nama Signature ' <br /> Y.ar <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name Signature Month Da Year <br /> - r <br /> i I <br /> 19.Discrepancy Indication Space <br /> F <br /> 20.Facility Owner or Operator Cenlfi<anon ar recaps or waste mammals co.ered by this momfesr except os nosed in Item 19, <br /> y <br /> Primed/Typed Name SignaWm Momh Day Y..' <br /> GENERATOR'S COPY so <br />