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I Generator's US EPA ID No 2 Page 1 3 Document Number <br /> NON-HAZARDOUS <br /> of <br /> WASTE MANIFEST <br /> NH-N° 2 1 7 9 <br /> a Generator's Name and Mailing Address <br /> Generator's Phone <br /> 5 Transporter Company Name B US EPA ID Number 7 Transporter Phone <br /> V. wr�nrf. O-ro t,_1. ( — S'o-t..:) - <br /> 8 Designated Facility Name and Site Address 9 US EPA ID Number 10 Facility's Phone <br /> �T"^ ..� T'�-..�!moi- �.��crac 3 ZO� r•.F f ��`�Co `�� �'C �� <br /> G 9YO-G 3 <br /> E 11 waste Shipping pprng Name and Description 12 Containers 13 14 <br /> E Total Unit <br /> A <br /> No Tvi3e Quant Wt/Vol <br /> A a fal2c�-.rr � <br /> T a� f <br /> O <br /> R b <br /> 15 Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> 113 lit) <br /> 18 GENERATOR'S CERTIFICATION I certify the matenafs deunbed above on this martdest am notAbie4o,4s or federal regulations for re rtnp vroper disposal of Hazardous Waste <br /> PnntedlTyped Name Signature <br /> T <br /> A CEJ W / 11 �� Year <br /> 1��!�L r r rGs✓ �anth G.S <br /> N <br /> P 17 Transporter Acknowledgement of Receipt of Materials -- - - - h <br /> O Pnntedffyped Name Signature <br /> E <br /> Month Day Year <br /> S <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> T <br /> Y aciitty Owner or Operator Certification of recei t of waste matenats oovered this manifest e <br /> p by xcept as noted in Item 18 <br /> Pnnted/Typed Name Signature <br /> Month Day Year <br /> MITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />