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errs 7c arse neve PCe�9 ,per• '-y'�, <br /> NON-HAZARDOUS1 Generators USEVA I No Manifest Doe No 2 Page 1 <br /> WASTE MANIFEST of G` <br /> 3 Generator s Name and Maohng Address <br /> C#E-Z/.e4.Oj � <br /> Z_,i� ILIC71 <br /> 4 Generator's Phbne( U , <br /> 7 r <br /> 5 Transporter 1 Company Name 6 US EPA 19 Number A Trans orter s Phone <br /> �N�r2v c� N OZ <br /> r <br /> 7 Transporter 2 Company Name 8 USE A ID Number B Transporter s Phone R <br /> 9__Dssignated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> ¢ 12 Containers 13 14 #h <br /> 11 Waste Shipping Name and Description Total Unit t# <br /> No Type Ouantity WWoI <br /> V01VILO&Z_" <br /> sy Z a <br /> G b <br /> E <br /> N <br /> : E ^ t <br /> R w <br /> A C j <br /> ` T <br /> rf O a <br />[ R , <br />`- d <br /> F 4 ' <br /> r <br /> r-ir <br /> ~ <br /> D Addi+local DEscr o,ions for tater+ais Lasted Abo%e E Harolirg Coces for lhcstes L+s'ed Above <br /> r- <br /> r <br /> Ir <br /> f i ,5 Special iinsirt-c ions and Addi,ioral Into maoon <br /> ?� <br /> i1 ie GENERATOR S CERTIFICATION I ce-i , he q-,Cr IS ccscr,bed Gbo e on -,s Tar,fesl are nct sub,Pct to fcocral regil,l o-s or repor irc,proper oisrc�al In,Hazcrcocs 'ate a <br /> - <br /> i FrintecrT peCtla a f ^ r'n,r Dg, tear <br />' TR 17 TranspoI,er 1 AC4noV%IEOCer'17-1 of Pi-Ce i W-,c 13 s <br /> A Pn +ted TtPec NiaiTe $i5na+ l �o car <br /> O 18 Transposer 2 Acicno%leCgerriert of Pece pt at Va Enais <br /> R <br /> T Prin ecf/Ttipeo Nan+e Signa,u e Month Day t ear <br /> E <br /> R l <br /> 19 D screpa-cy indic2,ion Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facilq� Ot+ner or Ope ator Certification of rece pt o`t%aste mateT,als cove ed by th s mantles,except as noted in hem 19 <br /> Pr rill ed Name Signatu rlonr^ t year <br /> Printed by J J KELLEH d ASSOCIATES INC 2-BLS-05 Rev 2/98 <br /> Neenah WI 54957-0368 <br /> ORIGINAL — RETURN TO GENERATOR <br />