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�i�nBd 89Of16lihB Ry OwAtBf �yk � e <br /> NON-HAZARDOUS 1 Generators S EPA ID NoMandest Doc No 2 Page 1 <br /> WASTE MANIFEST of <br /> 3 Generaior IS Name andVa:hng Address � <br /> CTI GGvv/ NI <br /> /// Cid' <br /> 4 Generators Phofie( O } r <br /> 5 Trans orler 1 Company Name 6 USE AID Number A Transporters Phone <br /> Ulf eAa7Z�-C, <br /> 7 Transporter 2 Company Name 8 U§EPA ID Number B Transponer s Phone <br /> 9�P5ignaled Facility Name and Site Address 10 US EPA ID Number C Facility s Phone y k� <br /> tivfr�Ji� <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No I Type Ouantity WVVOI <br /> 41 <br />& G b <br /> E <br /> N <br /> E <br /> A <br /> A c c <br />�« T r <br /> It d � <br /> G <br /> t' D Addwonal Descnptiors for Vale ials Listed Abc�0 E Handling Codes for Wastes Listed Above <br /> t � YO 1�/mac M-S <br /> L 5 Special r'andEing Ins,ructions and Additional Ir`orra-on <br /> f <br /> f <br /> wIV E-7�J ,�RN/�uf✓6 <br /> r <br /> r <br /> 1 16 GENERATOR S CERTIFICATION I terry he me ccsc rood abo,E cn h-TFm,est a e-o ��^,ec a Fede at regula'iors ter reposing proper dicpoQal of Nczardo,s Waste <br /> P r+ed'Tvped Na-rL i gm- I n Day ear <br /> l - <br /> TR j 17 Transpor'Er 1 Atmos ledce rent of Pcceip'of Ida =s <br /> A PriniiFv d Nam <br /> r N �J�J <br /> P <br /> Q 8 Transporle 2 ALKr)m ledg "e 'of receipt of Ilha e a's <br /> i R <br /> l T Pnn,ed/-r�ped'dome Sigra u e Mon n Day Year <br /> E <br /> A <br /> 19 Discrepancy indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20 Facifi,y Ov ner or Operator ;e7dication of receip'c' +ante rrafenals covered by tnis manifest except as noted m Eiem 19 <br /> Pr y r ped Name Signa rnonm Day Year <br /> Pnnled by J J KELLER 8 ASSOCIATES INC 12-BLS-05 Rev 121/98 <br /> Neenah W154957036$ ORIGINAL — RETURN TO GENERATOR <br />