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} <br /> I <br /> r: <br /> r <br /> NONHAZARDOUS WASTE MANIFE T <br /> Please print or type (Form designed use on akle{72 pitch)typewriter} <br /> NON-HAZARDOUS 1.Generators US EPA lO No, p nitasl No 2 Page <br /> WASTE MANIFEST <br /> 3,Generators Name and Mapktg Address ` —y �N E ny V 051ty-,E7NT 646LAC r <br /> ! E C4lANNL <br /> -r <br /> 4. <br /> WZ�t�t1 k.A <br /> C�C <br /> 4.GeneratorJs Phone{ 1 TQt'V` &-,J <br /> 5.Transporter 1 Compalty Namo fi. US EPA ID Number A SlaleTransporters ID <br /> 1 N S`yz�p(T I NC I B.Transporter 1 Phone <br /> 7,Transporter 2 Company Name 0. US EPA ID Number C.Slafa Transposers ID <br /> D,Transporter 2 Phone <br /> 9,Designeled Feality Name and Site Address. 10, US EPA ID Number E Slate Facliy6 ID <br /> gawffl <br /> C A=VM RD. R Facility's,Phone <br /> 660MM M <br /> 11.WASTE DESCRIPTION 12 Containers 13 14, <br /> Total Unit <br /> No. I Type Quantity W1No1 <br /> f <br /> e. �0 N— HOZ r� +� N 2- 1L 't>rm 0 (1 ML <br /> G b <br /> E Nc7n— I+ r?.r h 5--zA 4s W!} Z k ` (Z/V 6m, <br /> N <br /> E <br /> R c <br /> 300 <br /> A 1 'Drj I— of w J)" I l'7. irk, <br /> T <br /> Q <br /> R d, <br /> G,Additional Descriptions tar Materials Elated Above H.Handling Codes far Wastes Listed Abova <br /> C <br /> t15,Special Handling Instructions and Additional information <br /> C <br /> 16.OENERATORIS CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and ata In all respects <br /> in proper condrtbn for transport The materiels described on this mantfost are not subject to federal hazardous waste regulations <br /> Data <br /> Prinledrrypod Name Signature Month pay Yoar <br /> I <br /> T 1T,Transporter 1 Acknowledgement of Rocs pt of Materials <br /> R r Date <br /> S `�t`�t1r'1Lmeeme VLI"' " 1 2 Signature Month y Yaar <br /> 1 6 <br /> 0 18,Transposer 2 ACknow'edgement at Rocalot of Malenats flare <br /> EPrinied/Typed Name Signature Month Day Year <br /> R <br /> F 19,Discrepancy fndcaton Space <br /> A <br /> C <br /> 1 20 Facility Owner or Operator,Cenineaton of receipt of the waste materials covered by this maniieal.oxcopl as neted n ilem 19, <br /> L <br /> Oat@ <br /> Y Printed/TypedName Signature ManN 2y Year <br /> tCR W1—fi c f% <br /> F-14 02002 LASELAASTE110 (M:62t.saaa wwwiabelmselorcorn <br /> m Rev,3+95 <br /> J 1N <br />