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NON-HAZARDOUS *nwitherator's US EPA ID No. age 1 3,Document Number <br /> of <br /> WASTE MANIFEST NH—N° 2179 <br /> 4.Generator's Name and Mailing Address <br /> W-odc. <br /> Generator's Phone <br /> 5.Transporter Company Name 6, US EPA ID Number 7.Transporter Phone <br /> z�2-��tV• wc6Y^rte. c7a r 3 ( � ga--O - �{�t�l3CaZC,� <br /> 8.Designated Facility Name and Site Address 9. US EPA ID Number 10.Facility's Phone <br /> E 11.Waste Shipping Name and Description 12.Containers 13. 14. <br /> N Total Unit <br /> E No. Type Quanli WtNal <br /> T a �CRc...�e�.•������ � a�( TT, (aero <br /> O <br /> R b. <br /> 15.Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> tl�L� 11a. <br /> V o-1`t <br /> 16.GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not bjec o fe or federal regulations for repprting proper disposal of Hazardous Waste. <br /> if Printedffyped Name Signature <br /> T <br /> Month Day Year <br /> N 4 /�ll�L M�r'K�-�' <br /> S 17.Transporter Acknowledgement of Receipt of Materials <br /> P <br /> O PrintedlTyped Name Signature <br /> t� <br /> E Month Day Year`�S <br /> R F--�J / <br /> 18.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> T <br /> Y 19.Facility Owner or Operator.Certification of receipt of waste materla[s covered by this manifest except as noted in Item 18. <br /> PrintedlTyped Name Signature <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />