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e , <br /> TIM jNON-HAZAADOU$ 1.Generator to NwAbw 2.Page t o1 3.Emeiv Ra pM=Plto� 4.Waste Tracliing Nmnber i <br /> WASTE MANIFEST <br /> 7.RJyw <br /> 5,Generators Nam$and Meirmg Address tjowmWe Silo Address(d dMeranl then maling ) E <br /> F,'35lir3rl!t 1;c n'oSYt1{:�1t`i+:.rr�¢ / <br /> :[?S,Celli tit jVfeet ;O_"Mltnls! )fdE7 <br /> r , wli of fdll,u',a :;��[1Cti US n fR, A ''�(=> !'W!, <br /> Generators Phonxr, _ ^� <br /> 6.Transporter 1 C npany roe U.S.EPA lD Number <br /> iifik,i�Caa!Inrllt._�f:!d!�•:?tcl!':e% Chip;}':=C"•3 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> B,Dedynaled Fadrdy Name and Site Address U.S.EPA IU Number <br /> i-"r.C;v;Lt jr�Y!_'-'.iJi�C�Fii..1 t'.r r+��3!?•:7 i t. <br /> Faws Phone:71uTC,7 •4V-M-n <br /> 10.Coftners 11.T0[al 12 LW <br /> D.Waste 5hiPPb9 Mama and OasdsiDlion N0. TWO Qt"V WUVd. <br /> 1. ?:trP 1011^trrv:�?�+:I�ru �v=1i°"�?I;} ,S �'"•,�,.• .:,;;`.y'i..it- i <br /> H�Z1Yi u �,r. i 3h r .� 1 C r � '� �r to sr'� •, <br /> W i <br /> z .f: 2. <br /> 4. <br /> 13,Special Handling Instna tlms and AdManal Information ; <br /> own <br /> 14.GENERATOR'SlOPMOWS CERTIFICATION:r hereby declare thal she eo:derda of No censigrrnetd we luly and a=mt*described above by the prefer sNpping defile;and are dasdlled,packaged, <br /> marked and la0a�end are b all respects h proper condlQon for transport vwordrg to**able inlemalbnel and rmllonal govemmenlal regulations. € <br /> Generalorwo From Printed lT W Nems Slgem <br /> nre / rr Manor Ray you ; <br /> �-!7 <br /> .r 15.Inlemetbnaf Shlpme s ❑Import to U.S. ❑Emort from U.S. Pod o1 emryfwft ' <br /> r <br /> T nor SkRWra for iia On <br /> : Oats fee S <br /> le.Transporter ncNrwv4edgmWgfRacelgt04Meted* r �� <br /> I-- TranspoO.,APApVypd 6ignabrre Mo[dh Day Year r <br /> i V3 <br /> hG11 r DdY, Year <br /> sPodafLlP pwffYpd Name <br /> t7.DleaeparLy <br /> 179.Discrepancy Indcalm Specs '❑Ouiu%ty ❑TYPe ❑1asld0a ❑PaAia1 Rejection ❑FW Haled- <br /> ' i <br /> Marafest Retarmwe Number. <br /> 17b.Alternate Fadtli�y(or Generator) U.S.EPA 10 Nwtter <br /> n <br /> OL FWMY3 Phma: <br /> 17e Signature of Allemale Fecday(or Generator) Month Day Year <br /> t C1 - ;R•S ;t:r'Fa, :ern-`•3.•-r., <br /> j,.;.,, <br /> a L. �!51•,�iy �• T z r �. rr - 'S` { r t. •i J kt'?. t rS �� t t,t xf. <br /> i• ..Y s "i z +- r'4 f � --.yt�7 63 } aS s.i iF.-- •ver.rr�y�a+ a. h lr _ ��_ 54Y0. _, l_? yy f <br /> o •-a•L- :s% .K•, ,F .1 '� ..a, .t.�3. ,lk, .r.c: ,=5- _ rt't x ..�'4 <br /> la Daslgnafed Fa Aly Owner of Opemlor:Ce mon d fer:W of matedels eavered by the menbst except as noted In Ilam 17a / <br /> r <br /> PdnledlTyped Name Slgneluta ' ^ Mmh Day Year t <br /> 159-BLC-05 11977(H8u 9109) <br /> . dV! � <br /> I <br />