Laserfiche WebLink
eeaebm t orSype "Elm <br /> for a 2ylt {yp�r,rlter� ai � �l9 <br /> NON-HAZARDOUS 1 Generators US EP tD No Manliest Doc No 2 Pagel <br /> WASTE MANIFEST QdO J ps <br /> 3 Genetors Name an Mallrng Address e <br /> ,:,_7�vXo, <br /> Q/ / G7 <br /> 4 Generator s Phone( ) � <br /> 5 Transporter 1 Company Name 6 U ID Number A NtTran�pqp. one/ta G <br /> 7 Transporter 2 Company Name 8 U5 E.0A ID Number B Transporter's Phone k <br /> 9 Designated Fac6ity Name and Site Address 10 US EPA 0 Number C Facility s Phone ` <br /> 11 Waste Shipping Name and Description12 Containers 13 14 ' <br /> Total Unit <br /> A/ <br /> 1 }� No Type Quantity WWoI ' <br /> a A/DA /l/q L l LC <br /> � S <br /> G b { <br /> E <br /> N ` <br /> E <br /> R <br /> A c w, <br /> lc � R� <br /> d <br /> i� <br /> r <br /> D AAdndddiiloonal Descric,,ons for%1 ale I.Is Listed Abo%e E Handling Codes for VavSteS Lis ed Above <br /> t <br /> t - <br /> 5 Special handling lnsirLel Ons and Addi coral Worm.-on <br /> I- <br /> 16 GENERATOR S CERTIFICATION I cc�,'y ire c _s oesc i"Ed bo,e or "s r"anfcst a not s.,51ec Io'ecc al eg Int ans fo eaon,nq p ope Csposal of 1az,* co..s Lvat e <br /> I r r,r„ep i V:,Ed 1'zTe Sicn� r fon't Dai 7 par <br /> GI <br /> T I 7 Tranaponer I Acknoraledge—,e'-,t of Peceipf pirate e S <br /> R , <br /> A E d i��ec Nzme 15i n, a r DT— <br /> R1 1$ Trar'Spolle,2-cKnov,ecoemenl of Rccelpt of I late a s <br /> T Prir„eo/T,ped Name Signalu e - i;`Aar h Da} Year <br /> E <br /> R <br /> 19 Discrepant} Ina cation Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facdiq Omer or Opetafor Ceiilicalion of receipt o', ante materials covered by i7,s mande5t except as noted m nem 19 <br /> printer3ftped Name Signatur Haan Day Year <br /> IS f <br /> PnNed by J J KELLER a ASSOCIATES INC 1 <br /> Neenah WI5a957-0368 2-BLS-CS Rev 12198 <br /> ORIGINAL — RETURN TO GENERATOR <br />