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NON-HAZARDOUS WASTE MANIFEST <br /> r..print or type (Fom1 deli nod for umaaon dice(12 pitch)typowriter) . <br /> NONHAZARDOUS 1,Generator's US EPA ID No, Mnn fest P.PflgQI <br /> WASTE MANIFEST Document iVo <br /> 3.Gerrerator's Name said Mailing Address Y <br /> - 4.Generator's Phone( ) .W}�`� �.�.�r,,�. c 14 <br /> S.Transporter 1 Company Nano 6. US EPA ID Number <br /> ,�-- A.Slate Transporters 10 <br /> ....s Y.r H.Transporter 1 Phon o-7 <br /> 7.Transporter 2 Cornliany Name a. US FPA ID Number C.State Transportor's ID <br /> D.Transporter 2 Phune <br /> 9.Designated Facility Normo and Sho Address 10. US EPA 1D Number E.Slate FacRV's ID <br /> r <br /> r' JZ <br /> � ,.F.Fatilily's Phone <br /> Jf•.'i�' 1Iz5-/r•, � C GfC -r^i c-:-i �[3'�7 '�J. ' ��,�.. <br /> 11.WASTE DESCRip'noN 1.2. Ge lainors 13. 14. <br /> Total Unit <br /> No, Typo Qtlanlgy W1IV6, <br /> A. <br /> tx <br /> E <br /> N <br /> E <br /> f; c• <br /> A <br /> T <br /> O <br /> !U <br /> R d. <br /> a <br /> y G.Additional Dnssriptiats For Materials Listed Above H.Handling Codes for Weslns Efsted Ahoyr. <br /> 7 tt r <br /> 1 <br /> , <br /> Q Is.Special Handling Inslnruboas and Add@� m <br /> al Intorailon <br /> It <br /> {; <br /> Z <br /> :EEE <br /> i€ <br /> i 1S.GENERATOR'S CERTIFICATION:I heraby certify tical 11m wmlents of[his slIlDmont are fully and accufalely dwmbed and are in ao iespcOs <br /> F F in proper cur=dation for transport.The inateriatS described on this marriest are not subpol to laderal hazaiduus waste regultd'ons. <br /> � i <br /> Data <br /> !;! PrintecilTyped Plante Signature Month Day Yana <br /> If <br /> R77.Transporter 1 AcknorviEdQernnnf of Receipt o1 Materials Dale <br /> A Prmledlryped NameSignature Month Day Yea <br /> s P RA- ]Nr <br /> O 18.Transporter 2 AcknovAriooment of Rocetpi of Materials <br /> Data <br /> t � � PdntedfYP�Name Sgnafure s � <br /> Marrr> Day Year <br /> I # 19.Discrepancy Indication Space <br /> A <br /> C <br /> n I 20-Fealy ovmer oroporator;Certification of receipt of the waste m:.to0als covered by this manifest.extent as noled in hest 19. <br /> r L <br /> I Z _ Date <br /> T Prinied!TyMd Name Sgnaturl Month Day- Ynar <br /> I <br /> t t F-1 N)02 l.�.Y2:[7y}-v S'fFR�;tStX7f U21:r3Ufl ;vww}attalmasisr.eprt r>Er:�tto wnecxe�aru�n rf ,i;,;,-„awl:' Rnv.3;95 <br /> 1 Ute=::ourt�!t,cn �✓.S�O11fNK <br />