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NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Pa e 1 <br /> WASTE MANIFEST ©0_ C> <br /> 0_ mo o° <br /> 3 Generator's Name and Marling Address <br /> C11'1N f <br /> 4 Generators Phone ) <br /> 5 Trans orier 1 Company�Name 6 US EPA ID Number A Transporters Phone <br /> d� - R2CP 3`�0 <br /> 72, <br /> 7 Transporter 2 Company Name a US EPA ID Number $ Transporters Phone <br /> 9 esi ryatedliit Name and Site Address 10 US EPA ID Number C Facility Phone <br /> 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit <br /> No Type Quantity Wt/Vol <br /> a <br /> G b <br /> � s L�+a CSU � <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> r O <br /> R <br /> t d <br /> 0 Addtional Descriptions for Mater als Listed Above E Handling Codes for Wastes Listed Above <br /> I � I <br /> 15 Special Handling Instructions and Additional Information <br /> 4 <br /> 16 GENERATOR S CER FICATION I candy the materials described above on this mpatteware not subject to tederai ulations for reporting proper disposal of Hazardous waste <br /> P yped Nam�n � L l atur \ Month Day year <br /> r T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R Month Da Year <br /> S ri led/Typed Names4 A Si nature tMo <br /> t <br /> P <br /> O 18 Transpo er 2 Ackno ledgement of Receipt of Materials <br /> R <br /> T PnntedlTyped Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> s l 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Y <br /> PnntedlTyAed Name Signature Month Day Year <br /> rr <br /> Fa>...;uy�a_.f ^�wMw4 -,1�,—jr:�''F�tr-^�-•.,� k' F'� .t !�. ,�j*�.,�wx„F'��'+(t'k���[�E�txg�'x�r�� <br /> !! PrirMed b1 J d f�LtER>f AfaSOCIATES I1JCs �r <br /> � �02-BLS-05 Rei° 12/98 -� <br /> lJeanef16 VA 54%7-03% <br /> `" GENERATOR'S COPY <br />