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�r <br /> + <br /> �d Qrre'a� soocretlre 1z-pft lypewrfter],� <br /> NON-HAZARDOUS t Generators USAID No Manifest Doc No 2 Page 1 <br /> WASTE MANIFEST of <br /> 3 Generators Name and Mailing Address <br /> G/_xcvRJAIII <br /> 'fit vV 12, o p� J C-A <br /> 4 Generators hone(Zd9 ) 6 7 <br /> 5 Transporter 1 Company Name �O 6 US EPA ID Number A Transporter s Phone <br /> 7 Transporter 2 Company Narre 8 US EPA ID Number B Transporters Phone <br /> 9 tgnated Fac0ity Name and Sile Address 10 US EPA ID Number C Facdity s Phone <br /> �f <br /> ��-h�&4_�y <br /> L44' �302-1/ <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br />~; No I Type ouantity 1NWcl iAS <br /> a ILO/11 YAZ (,c�ft SQL Lr�U1 f`,a( / .� <br /> b � <br /> N <br /> r; <br /> R <br /> A C <br />`rte T a <br /> R - <br /> dr <br /> Additiona4 Dcscrip,iens for Materiels Listed Above E Handling Codes for Vlas,es Listed Above <br /> I <br /> IS Special Hanplrng lnsirucliens 2nd1AddrUonal Into m. Gn - <br /> t <br /> 3 <br /> y <br /> 16 GENERATORS CERT#FICATION I ccrr'y 17,Ta= J CCscn ec abc c on h na-ii +a C r,oi s,.tlec� o fete of rcgu a.,i-s or eport ng p cper❑sposal of rlaza cl,�s 1 es e <br /> ped Name Si r fpr 7 par yea, <br /> L_z r v r <br /> T 17 Transporer 4 Ackreti lcogenien,C1 Rece pr of Ma E ors <br /> R <br /> A pi,1 di}}p/ed�hrame 1 { SrCr o, ��Jr�l fr on7 Dn I'tear <br /> O 18 Transporler 2 Acknoti ledoement of Receipt of f0a,E o c <br /> R <br /> T P inled+T.ped Name &gnatu s on h o,y YEa <br /> E <br /> R <br /> 19 Discrepancy Indica ion Space <br /> F <br /> A <br /> C <br /> 0 Facdty 0, ner or Operasor Ceni kation of receipt o'%}este ma enals CotCreo try his manifest except as neteo in I,em 19 <br /> PrintedlTyped Name Signatu rIon h pay )ear <br /> Printed by J J KELLER&ASSOC{ATES INC 12-BLS-05 Rev 12/9$ <br /> Neenah Wi 54957.0368 <br /> ORIGINAL — RETURN TO GENERATOR <br />