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5�lesse�nrty{s� _ <br /> (Porro flnad onelRs�72pitdrJiYPa3FL <br /> NON-HAZARDOUS 1 Generators U EPA ID No Mandest Doc No 2 Pagers <br /> WASTE MANIFEST of <br /> 3 Generators Nam and Mailing Address <br /> 4 Generators Phone( <br /> cr-­(Y7} -7 DC7 (o <br /> 5 Transporter 1 Company Name 6 US EPA I Number A Transpon ho e <br /> .�N ✓ �� /lf - oZ d <br /> 7 Transporter 2 Company Name 8 US EPA 10 Number EI Transporter's Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> ��,' ✓� v PG � GcJQ x <br /> 44 <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity Wtfvof <br /> a^ <br /> a NOA/ Z LJ,�9S7C_ L 4)C{ 0 <br /> .4 i f — <br /> N Al <br /> E <br /> R <br /> ` T d '. <br /> r 0 1 <br /> VR <br /> r <br /> d �W <br /> ,r <br /> Y < <br /> .1 <br /> _ <br /> ED Add',ona'Cescr,p,ons for I4a=_r a's L:sted Abcte E Handling Cooes for Was.es Usleo Above <br /> , <br /> `r <br /> f 15 Spec al na^,oling InstruC Ions and Adoioorul 11iCM aL on <br />� I , <br /> .6 CEN'ERATOR S CERTIFICATION f to^ v e r r =s nest,b 6 aco [o t1G mar P5 l e ro s_C,-CL c'cde..I rcgu a,io^s'or 5e <br /> k Pn^ted 7�Ned —G^ —�—E—� • 7.cr i,.y lcar <br /> I LL� i l - <br /> T 117 7ran_po-ar tlrKno� leoo9"le-31 Rece of of f ie e ia15 <br /> R , <br /> Ar.Eo Ty ced Varve <br /> P ,� � �,f « �� , L� -� i _ �— gin� � l l/ �c <br /> 0 18 Trrns,�o�er 2 Arknol 'edcc Beni of Receipt of h1.te ia's <br /> R <br /> E 9 Prir.ee7 ped Nome Signature tear <br /> R ! <br /> .9 Discrepancy Indication Space <br /> F <br /> A <br /> G <br /> i <br /> 0 Facd,'y 0[ ner or Ope a.or Cer,f ca.on of rece pi o' %aSte rlalcrwls covcieo by,h s manifest excepl as noted in liem 19 <br /> Y Pnntea,7tiped Name Signaiur / Mon h Dar Year <br /> Pnnted by J J KELLER S ASSOCIATES INC 12-BLS-05 Rev 12198 <br /> Neenah WI 54957-0366 <br /> ORIGINAL — RETURN TO GENERATOR _ <br />