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, r <br /> NON-HAZARDOUS WASTE MANIFEST <br /> NON-HAZARDOUS 2-Page I <br /> WASTE MANIFEST D' X11 of <br /> a.Generators Pp I- <br /> T:3^11J^e1 CJT r: -i US EPA "'; A.Star, <br /> B.T.r,p,:r . <br /> D.Transp:> -. <br /> ,hated Facmry Name arc Sce Aodreas _ US EPA:1:Number E Stare Faa,r,_ <br /> F.Famhty's Phone <br /> ✓.ASTE DESCRIPTION 12. Containers iA le <br /> No. Type <br /> E <br /> E , <br /> R r <br /> A <br /> T <br /> O <br /> 1 <br /> R a. <br /> CG Atl60onal Descriptions for Materials Lotted Above H Handling Codes for Wastes Gsted Above <br /> ) <br /> ) <br /> ) <br /> ) <br /> 15.Speeml Handling Instructions and Abttional Infoneaaon j <br /> -.0 L ''i� <br /> U, .�:,. <br /> 16.GENERATOR S CERTIFICATION .. -. -. ._.._ .. <br /> Dale <br /> P.mred7 peo Name Srgnamre A/rv.rh Day Year <br /> Ili <br /> T 17 Trarw"Jer 1 AcknoWedgemenl of Receipt of klitenaL Date <br /> A P'WJITyped Name _._ Siyypurev "C"M Day Year <br /> S <br /> pIB Transponnr 2 Acknowledgement of Receipr of Materials Date <br /> TPnntedRyped Name S�gnalwe conn+ DaY vea. <br /> E <br /> R <br /> t9.Discrepancy mdieaoon Space <br /> F <br /> A <br /> C <br /> 20.Frei Owner or Operator CefXficalion of receipt of the waste materials coyered by ttus manifest.e=epf as notedel item 19. <br /> L Da.e <br /> T yr nfed7ypexf Name NloPM Day rear <br /> CP114 LA6E1161ASTFR'''' _._.:.. -10R www iabelmaaer coin. <br />