Laserfiche WebLink
✓ .. *fir <br /> NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type Form designed for use on elite(12 pitch)typewriter) <br /> NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page,;, <br /> 'r 's t a.a3�� .I '� Document No <br /> WASTE MANIFEST -�� <br /> a.cq 1 Pry r e•.end Vail'll. Address <br /> 4.Generator'sPhone i t'".�t'�''y�'�;! .•, „ <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporters ID <br /> B.Transporter)Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C-Stale Transporters ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and She Address 10. US EPA ID Number E.State Facillty's ID <br /> 4_'.a': F.Facility's Phone <br /> 11.WASTE DESCRIPTION Containers 13. 14. <br /> Total Unit <br /> No. Tyoe Quatdlty Wi <br /> G <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> R `t' <br /> W <br /> jNG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> O <br /> Q <br /> cc 15.Special Handling Instructions end Additional Information <br /> If kril <br /> r • <br /> z <br /> O <br /> z LA <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contorts of the shipment are fully and accurately described and are In all respects <br /> in proper cenditron for transport.The materials described on this manifest are not subject to federal hazardous waste regularoos. <br /> Date <br /> PriniedlTyped Name Signature Morrh Day Yea. <br /> T 17, Transporter 1 Acknowiedgement of Receipt of Materials Date <br /> A Pnntedrryped� me 8lgnatwe Month Day Year <br /> N �'7'�rr,.ti► . 'r,fi..•sI r1' ..✓ Ytir`' w �_.:� :7f <br /> P <br /> p 16. Trensporter 2 Acknowledgement of Receipt of Meter" Date <br /> T PnntedlFypad Name f'a1gn81Ufa Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> A <br /> C <br /> L20.Facility Owner or Operator Certification of receipt of the waste materials covered by the manifest,except as noted In nom 10. <br /> Date <br /> T Printed/Typed Name Sgnnnrre Manch Day Ypar; <br /> y i <br /> CF14 02002 LABELMASTEA® (800)621-5808 www.labelmaster.com I <br />