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NON-HAZARDOUS 1 Generators S EPA ID No 2 Page 1 3 Document Number <br /> of <br /> WASTE MANIFEST NH-N° 2173 <br /> Generator s Name and Mailing Address <br /> Generators Phone ..��� 5 <br /> 5 Transporter Company Name 6 US EPA ID Number 7 Transporter Phone <br /> a Designated Facility Name and Site Address 9 US EPA ED Number 10 Facility s Phone <br /> G <br /> E 11 Waste Shipping pprng Name and Description 12 Containers p13 14 <br /> ial Unit <br /> E No Type Quantity WI/Vol <br /> R a <br /> A <br /> TO <br /> A b C <br /> 15 Special Handling Instructions and Additional Information Handling Codes for Wastes listed Above <br /> 11a 11b <br /> 16 GENERATOR'S CERTIFICATION I Certify the materials desenhed above on this manifest are not subject to state orfederal regulations for reporting proper disposal of Hazardous Waste <br /> Pnnted/Typed Name Signature <br /> T <br /> A Month Day Year <br /> N � {'' <br /> S 17 Transporter Acknow-4dgement of Receipt of Materials <br /> P <br /> a PnntedlTyped Name Signature <br /> R <br /> T � 4� r--� � Month Day Year <br /> R � <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> *Faca�dltyC,ner or Operator Certification of receipt of waste materials covered by this manifest VcW as ed In item 18 <br /> PnntedlTyped Name Signature <br /> Month Day Year <br /> ye Z <br /> WRITE--ORIGINAL(Return to Generator) Y LOW—TSDF(Retain Copy) PINK—TRANSPTEA COPY GOLDENROD —GENERATOR S COPY <br />