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NOSiAZARDOUS WASTE MANOST <br /> P:aase prim cr typo (Fpn"Adesigncb for use on elite(12 pitch)typewriter) <br /> off <br /> 2.Page <br /> NON-HAZARDOUS 1 Generata's US EPA ID No. Manifest <br /> WASTE MANIFEST Document No. 1 <br /> 3.Generator's Name and Mailing Address <br /> 5AII"TTIk F6 �gILr�Ay �G1J UU2 <br /> '60i S7 <br /> 4.Generators Phone( ) y'T(r-k-?"p/U <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Tra eporter's ID <br /> I"STI< A7INC B.Transporter 1Phone <br /> T.Transporter Company Name 0. US EPA 10 Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 1D, US EPA ID Number E.State Facility's ID <br /> F.Facility's Phone <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> pp � <br /> No. Type .•Quantity WI.NOI. <br /> T� <br /> a I110N'I'4 F'E'Z {�'(�)6l C.e^TT7NGS 'i .6^�C� .135 <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> O <br /> L R d <br /> n <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 7 <br /> n 13aowN7 �utL e3o G>oR <br /> x <br /> a <br /> 15.Special Handling Instructions and Additional Information <br /> Z <br /> D <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I herebyY cedify that the contents of this shipment are fullyy and accurately described and are In all respects <br /> in proper condition for transport.The motorlals described on this manifest are not subjecl to federal hazardous waste regulations. <br /> Date <br /> PnntedTyped Name Signature Month Day Year <br /> T 17.Transporter l Acknowledgement of Receipt of Materials Date <br /> R <br /> A Pnnle /Typed Name Signature - Month Day Year <br /> P ,tu <br /> p 18.Transporter2 Acknowledgement of Receipt of Materials Date <br /> R Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> j 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Prinledrryped Name SignatureMonts Day Year <br /> Y \tct+AEL WF1s-FE+IEY19 k_,P_j G.-:e., 51 2q 1 13 <br /> F-14®2002 LASELAASTER0 (800)621-5808 www.labelmaster.comEoxtvx Rev. 3/95 <br />