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r <br /> . Pfelas Ar�ypO0 <br /> An oliEB 12 p1t r)typayrrtter a F n <br /> NON-HAZARDOUS 1 GeneralorsUSE44IDNo Manliest Doc No 2 Pagel <br /> WASTE MANIFEST of <br /> 3 Ge'n/�to�P,sName nd Ma g Address <br /> 4 Generators <br /> PtSone-� <br /> 5 Transporter 1 Company Name D 6 UP2 ZD Number A Transp ner' Phone � <br /> 62,11 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> u� <br /> 9 ignated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> 11 Waste Shipping Name and Description 12 Gontalners 13 14 <br /> Total Unit <br /> No Type Quaannnt/ilyy�J WtNol x <br /> E b I <br /> N <br /> E <br /> R <br /> t; A c <br /> T 5w <br /> I d <br /> D Aoditional Descr pt-ons for h4atertals L sled Abo%e JE Handl r,g Codes'or svas'es tined Above <br /> k <br /> 15 Special Handling In51rLC'ions and Additional lnforma ion <br /> 6 GENEPATOR S CERTIFICATION l cc-,,Y lYhe ra er air de<_C ine;above cr r s mai i'cst are ner s,.t cct o r c- cl cep c ops for rei Frc cr=-,c,al of Hata dei,a a <br /> Panted TNped N-11-ler Qj 2-a j11innh Pav YrPr <br /> z � I <br /> T 17 Tranrtporle t cano„'edocment c!Rece pt of Mage als <br /> R <br /> A P n1cc171-- I.-me �� I Signa V2 Azo^h 06v ea <br /> O 18 Transporter 2 Ackno leocemen+of Receipt o'Matcr as <br /> T Pr nled/T�red Narne Signcture Vornh Day Y ear <br /> E r <br /> R f <br /> 19 Disc epancy Ind cation Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Fac,ht} O�%rer or Operator Ce Vacation of icceipt of %as e male ass co+e ed by this man fest except a$noted in hem 19 <br /> P ?ped Name Signa 'p Mo n Div year <br /> PnntedbyJ J KELLER&ASSOCIATES INC <br /> Neenah WI 56957 0312-BLS-05 Rev 12198 <br /> 68 <br /> ORIGINAL — RETURN TO GENERATOR <br />