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rtlsBse pAr11A ����^ s3�.h^+ <br /> NON-HAZARDOUS 1 Generators SEP ID No Maztlte l 4oc No 2 Page t <br /> WASTE MANIFEST (i�JCy�/�� of <br /> n <br /> 3 GZenerra}}orrss arpand eIhng Address <br /> 4 Generator s P one�2 0,7 ) <br /> 5 Transporler 1 Company Name 6 US EPA Number A Transposer s Phone , <br /> 7 Transporter 2 Company Name 8 US 0A ID Number B Transporler s Phone <br /> c- <br /> I <br /> 9 Deslgnated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> t <br /> Il <br /> r <br /> 5 _ <br /> 12 Containers 13 14 <br /> 11 Waste Shlppmg Name and Description Total Una ° <br /> No Type Cluanllty WUVoI z <br /> b <br /> E ' <br /> ' N <br /> E Y# <br /> A c ._ <br /> T <br /> f O <br /> R d ^5 <br /> r <br /> I <br /> r D Additional Descnplions for rle,enals Llsred Above E Handling Codes'or V�astes Ls1ed Al Is- <br /> I <br /> 17 <br /> L� <br /> r 15 Special Hand,ine Instruc,lons aro Add,onal I-iforr�a,lcr <br /> 16 GENERATOR S CERTIFICATION I cera y he r a e I ,s CEEc lied roc e o- s mar rea are rot sLtlect to tecrral regia io-s for reaorir c p oiler c,cpcsai o1 r'azareo.s Lias e <br /> F'ti__i-o'T oel r -,re Is, <br /> 1 for h D2y 1 ar <br /> CSI L c. ! ,J / v k�vl <br /> RII 17 Trz.-spo^er 1 :IFno iecger-ent of Pece pt of Ma'e ais Y <br /> A I ¢ring- r ` n8 J Signa e.r <br /> N / � D d <br /> � ��—�� ` <br /> O a 18 Transporter 2 AcknotNIedeer-ient cl Peceipl of Arictcr tis <br /> R <br /> T Fnnted'Trped Nam111 1 D2e I Slgna,�re Y Ycar <br /> E <br /> R <br /> 19 Disc epancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Faciloy C% her or Operator Cell ication of receipt c',Aasle materials covered by this manifest except as noted,n Item 19 <br /> Prin+ d Name —a'tui , 14cm1i Day tear <br /> c. <br /> Printed by J KELLER d ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WI 54957-0-168 <br /> ORIGINAL -- RETURN TO GENERATOR <br />