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- 4 t <br /> a. <br /> _r <br /> r <br /> NON-HAZARDOUS WASTE �MA�NIPW. <br /> Please_pdM or C - (Form designed for_vse.an allle{12 It ),tybewdterl , � <br /> II a finewet .. _. <br /> WASTElIAN[FEST 1:Qenerntofs US EPA I©No: { wj�nt NO 2. ge t <br /> NON-HAZAFRDOUS D <br /> r 3°ReriBratofs Name'end.Metlf:tg Address' .f� � { - <br /> �+fI� <br /> 4.Generators E?hona(' ) 7 C'tf ' t- � • <br /> -175 EPArDNurnher - A Staleransporter's - <br /> IU <br /> - Nam© _ f3.Transp odor 1 Phon< ,O - <br /> r- sw rY <br /> 7.Trenspnitrir 2 GoRipanY Name 6, US EPA ID Number: C;Stale Transpertae.ID F <br /> ' 9.O¢sfed Facility Nerrieand Site Address .._ _ 10. ;US'EPR.10 Number ,? :d.'Transpvrte 6 n®. <br /> LYi'"J - 'E-State Fad s <br /> radrWi,Phorie <br /> 11.WASTE DESCRIPTION_ 12 .Con[a nerE 13• 14 N <br /> .: Total t3riZ <br /> taa,. ' r ,ryes Quamity Wal. ., <br /> - <br /> f <br /> 611 <br /> b. <br /> a E, <br /> i d ' <br /> G..AdditionaLDescriplians for t+RateriaLa Listed kbove k.FWndiiri9 Codes for WasW Usled Above. <br /> ; �- .i <br /> Q <br /> ' 15.Spacial Handl;npIristnictfantcrrindAddilionatlnlomwNon ..� -... .- ... . _..-,.. - - <br /> 4 <br /> Zmi <br /> } l <br /> AFMAW AFAVAU'Aff AV AW <br /> "Id.GEkERA7ows CERTIFICATION:1 hereliy certify lhit.ttm currtanls of IN s shIpmant,ire fully end-accurately descbbed�and are in all reapecls - <br /> in propercondillonfor transporL The materials describodon.lhia mantlast s wnla tb act to lodoial hazafdous,waslB rdyulal?ons: - <br /> Dow <br /> Pr)nl&wTyped Name Signatures - Morilh Day Ywr <br /> 17.'kanspofler 1 Acknow[edg' nerLL.P.nl of Receipt elivlaterials -; r 'Gate <br /> R <br /> APrirnadtfyped Name' _ 'Walure. ., -. -MONA� Day 'loaf' <br /> p 18.Transpoder 2 Adino%iedgemen[of Reoolpt o1''tdateriels Date <br /> RPdntedfTyped Name Signature _ Month. Day Year' <br /> IIW �- <br /> 19:61scr®{i. y Indicatbn Space - <br /> 20--.F`eality Owner or;4era3or:Cerlflicauon,of-roceipt of the wast,ma.?eAaiS.covrared by(tris mant;osl„except as rioted in!tem <br /> :."F..' -._ _ i '• - 'Date <br /> T : Prinf -�-iName. <br /> �ilg�grr�c��s:.<��!'t��"�. �'.��.^^•"L,e� .. . Aiorrih. bay Vadr.! <br /> .. ri+.vr*ocvi>�c�cteuai:rea Zry;h, :N °: lieu 3,85' <br /> f r1.3�?r772 E.AS7F.Et�.�.t5'fF.R'�E1XI>FIts21.5608 svww.Ir3itakria9kEr.co`rn .- <br /> S wxll svrhwl P€r: 17V INK,, <br /> ij il; <br />