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NON-HAZARDOUS I. Generator's US EPA ID No. Manifest 2. page I <br /> WASTE MANIFEST _ , ac mg t <br /> of <br /> 1. Generator's Name and Mailing Address�'^;1: <br /> 1412 7-C 7-M a'T J1r '.ey J' n�T J YU <br /> 4. Generator's Phone( y '— t <br /> ally: 1 ^fdLi;•fv <br /> 5. Transporter I Company Name 6. US EPA ID Number <br /> 1:Vz.?'.1 x'T: .">,'_`t4s i'x. C_"i'r I S . _.'I.L.Q .0 J) .I) .7 7 i .9 <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. Tronsponei s Phone <br /> ZT�SS.Ir11+Oi� <br /> 9994) �u.1..�': r:r—mmF M.-O S. Transporter')Phone <br /> C. Facility's Phone <br /> 7fO <br /> 11. Waste Shipping Noma and Description 12. Containers 13. 14 <br /> Na. TypeTotal Unit <br /> a. <br /> Quantity Wt Vol <br /> n. <br /> Is. .- fr F v <br /> E <br /> N <br /> O <br /> H <br /> 7. Additional Descriptions for Materials Listed Above E. Handling Code'far Waatas listed Above <br /> `moi 1301C 03 <br /> 15. Special Handling Instructions and Additional Information <br /> 747 <br /> 16.GENERATOR'S CERTIFICATION: I ctmty the mmenaa described above on this marls,, an not waits,to laderal regulations tar repomng proper disposal of Hasordous waste. <br /> Printed/Typed Nome Signature / Month 0ay Year <br /> R <br /> 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Signature <br /> y Month Oay Yegr <br /> zie <br /> 18.Transposer 2 Acknowledgement of Receipt at Matarioh <br /> E Printed/Typed Name Signature Month Day Year <br /> 1 <br /> 19.Discrepancy Indication Space <br /> F <br /> 1 <br /> I <br /> 120.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> 3 Printed/Typed Name Signature Month 0av Year <br /> PA <br /> GENERATOR'S COPY <br />