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RECEIVED <br /> ,a NON-HAZARDOUS WASTE MANIFEST FEB 17 2016 <br /> -PWM print or type (Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generators US EPA ID No, Manffest 2.PageI <br /> "WASTE MANIFEST Document <br /> " ENVIRONME Tql f <br /> 3.Generators Name.and Mailing Address jJE! LkeC <br /> 4 <br /> 104 W. 13$VE94L-j !t-At- Caf — <br /> 4.Generator's Phone( ) 'T1iCflL.'0t 6,p8 - <br /> 5,nansporter 1 Company Name // 6. US EPA ID Number A.State Transporters ID —rsl <br /> )NST V R't tfJ C I TrenSpod )e t F- <br /> 7.Transporter 2 Company Name 5. US EPA ID Number C.Scale Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and She Address 10. US EPA ID'Number E.State Facility's 10 <br /> NSTRAN <br /> IM CAWWOWF.Facility's Phone <br /> R10 V81K CA"WI I <br /> 11.WASTE DESCRIPTION 12. Containers 13. <br /> Total Unit <br /> No. Type Quantity W1"Vol <br /> /vr~)t+J—.HRZ_ �rS)LL C,.(F..r-rt N6 Yt'"� r1„ <br /> G b. <br /> E <br /> N SGL t� tit pt^L(L. D t.Fn <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R d <br /> ) <br /> G.Additional Dascnptiom for Materials listed Above N.Handling Codes for Wastes Listed Above <br /> 3tzt>W rsaf Ld y �3f2 tLOr 1�1c <br /> 1 15.Special Handling Instmclions and Additional Information <br /> 1 <br /> 16.GENERATOR'S CERTIFICATION:I hetebycerdfy that the contents of chis shipment 1uMy aM accurately described and are.in all respects <br /> in proper condition for transport.The mater described on MIS manifest are nm subject to federal Imzallous waste regulations. <br /> E777D; <br /> Primed/typed Name Signature Month Day year <br /> T 17Transporter1 Acknowledgement of Receipt of Metenale �' Date <br /> APllm6d?yled Name Signature r,r r'y as f� Month Day Yew_ <br /> 0 18.Transporter 2 cknowledgement of Receipt of Materials r Dale <br /> R. <br /> T PrintedrTyped Name SignaWre Monfh Day year <br /> R <br /> IS,Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> ) 20.Facility Owner or Operator;Cbrbfiradon of nXisPt 01119 swas materials covered by MIS.madilest,except as noted in item 19. <br /> I <br /> T. PrimedRyped Name Signature MmN Day Year <br /> Y mt( t+ael_ <br /> F-1402002 LAJKL01ASTFA® (800)6215808 wwwJabelmastercom tm Hev• <br />