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NON-HAZARDOUS 1 Generators US EP ID No Mandest Doc No 2' Pagel <br /> WASTE MANIFEST Q of <br /> 3 G ner tors Name and Marling Address <br /> revleak <br /> 4 Generators Phone( ) G`7 QQG 77/L-? <br /> S Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> .�ivc1,',ep e ` '�4f- X11 <br /> 7 Transporler2 Company Name B US EP 3D Number B Transporters Phone <br /> 9 Designated Facility Name and&1e Address 10 US EPA fD Number C Facility s Phone <br /> 3V-Oa-1 <br /> ti <br /> 11 waste Shipping Name and Description Containers 13 14ptian Totai Unit <br /> y No Type Quantity Wtrvol 3;A <br /> a <br /> PP15 0 �. <br /> G b <br /> E ` <br /> N <br /> E <br /> R <br /> A C <br /> T <br /> R <br /> r I <br /> d <br /> Id D Aad Uonal❑escoations for Mc errals Listed Above E Handling Codes for 14'asles Listed Above <br /> IS Special Hc-idling]ns ruclions a rd 4dortional In"orma'ron ; <br /> r " <br /> I yi <br /> r - <br /> i <br /> 16 GENERATORS CERTIFICATfON I CC 'y he�01e i_.s aesc -,td ebo,e o, r s rra" est are no subject to eoe-rI eou[F I ers to Icpehrr g p cae c SPG sa,o'Haz.oc is 1t'es,e <br />' Pn-rted7%redNa-ie Sig�Y l44nh Cay rear <br /> Ri o7 Transporer 1 Acknc�%lcdger ert of ecce pi of,V,�Ie a's <br /> I A PrrntedrT+peo Name SigraiuiL h,onfh Ccy Yee! <br /> N <br /> S — <br /> i P <br /> O 18 Transporter 2 Ac-rc� 'edgement of Receipt of Kla,enals <br /> T r Pn^' o�Typed Name S cra1Sre ' hac f-- D Year <br /> E � <br /> R �� /�.7 <br /> I 19 Discrepancy Inoicaion Space <br /> f - <br /> F <br /> A <br /> C <br /> I <br /> 20i <br /> O+ner or Qperator Ce idicatron of receipt of as,e m2terirls coti a ed by this man.ea e>cep as no ed m Ite 19 <br /> N ped Name Sri iy noon n Day Year <br /> Pnnied by J J KELLER&ASSOCIATES INC 12-BLS-05 Rev 12/98 <br /> Neenah WI 549570368 ORIGINAL — RETURN TO GENERATOR <br />