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NONHAZARDOUS I.Generator ID Number 12.Page 1 0l 8.E heig I I 1 Response Phone 4.Wade Tracking Number <br /> WASTE MANIFEST C A 6, fF <br /> 5 GenerabYs Neme antl Mailing Address � ? � ` '� � �' � ' � <br /> vim. "µ.,hitly" !#.}t:.(',;�pjyppd yy�sx Geneatofs Site Address(if tliXerenl then mailing atldress) <br /> 1040 NWU%Y4M1 01YYlW <br /> gWt1D/f CA ON06 <br /> Generator's Phone: 203 ",d-`All <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> rak4R kr?5) 1v*FRI NONE-r ssi C A R !S � <br /> 7.Trensponer 2 Company Name U.S.EPA ID Number <br /> Cl(�a�lfD�filali50RR5rbF�)Sc^Psk°.s8.'a <br /> B.Desgnated Facility Name and 5Xe Address LLS EPA ID Number - <br /> VLS-An=f <br /> 101&0M FWK <br /> le-PtOt M TN 38474 <br /> Fac,li 's Phone: sm 'y79-9642 T <br /> 9.Waste Shipping Name aM Description 10.Gantzinsm 11.Total 12.Unit <br /> No. Type Quantity, wwd. <br /> a: 1 14a1.F18YAfdD114i Nkiho Ltgr,�(Ag1g� '; ,- "' <br /> all <br /> 2' <br /> 4, <br /> 11 Specul Handing Instructions antl Aomucmu lmormslion --- --- <br /> i <br /> 14.GENERATOR'S CERTIFICATION;I cerfay the melsdals deecdbed above on this manifest are not subject to federal regulawns for reporting pmper disposal of Hazardous Waste, <br /> GenemtoYslOXeroYs Pdnkd?yped Nems Signature <br /> X r / Month Day Year <br /> .tib . r :�E.a.v.�..e/„... <br /> 15.International Shipments <br /> 1- ❑Import to U.S. ❑Expon from U S Pod of entry/exit ' <br /> Trans der SI lure for exports only), _ Dece lea' LLS.' <br /> M 16.Transporter AcWwwledgment of Receipt of Materiels <br /> Transporter 1 PrtnteNTyped Name S'nature V <br /> O .„ e / 5 9 Month Da You <br /> GL Transporter 2 Fnntedlryped Name SlgreWm f <br /> d Month Day Yew <br /> t]Discrepancy <br /> I 17e.Discrepancy Indication Space Quar” Type gaeiduen <br /> ❑Penial Rejection ❑Fu0 Relaclbn <br /> Manifest ftelerxwe Number: <br /> 171b.Alternate Facility(or Generator) U.S.EPA 10 Number ' <br /> U <br /> �l <br /> LL Faciliys Phone: ; <br /> C 17C.SgnaWreaf AXemate Facility(or Genemioq <br /> Month Day Yea ! <br /> O � <br /> 1S.Designated Facey Owner or0perstor Certl Aum of m,gin,o/mete,,Is mvmed by the manifest except as noted in Xem 17a - to <br /> Prmled/Typed Name <br /> Signature Month Day Yegr <br /> 16"LC•0 6 10498(Rev.8/06) �� TRANSPORTER$2 <br />