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-- - - -- - ---- <br /> NOWHAZ.ARDORR VNAS E MANIFEST <br /> Please print or type (Form designed for use on aide if tich) lypowmar) <br /> NONHAZARDOUS 1. Generators US EPA ID No. Manifest Z. Pagel <br /> WASTE MANIFEST Doaumpm No yb f q of 1 <br /> 0. Generators Name and Melling AddressT, , /'� <br /> 4. Generators phone ( ) � -� � �} .:J <br /> S. Tmnsprin 1 Company Ne ne 6. US EPA ID Number A. Slala Transpodere ID <br /> B. TrensiortmlPhona )p7 v ,y- <br /> T. Transporter 2 Company Name 0. US EPA ID Number C. Slate Transporter's ID <br /> D. Transporter 2 Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number E. Stale Facility's ID <br /> 3 o• fvrrs_ -F <br /> �kN r r - Facillys Phone <br /> J <br /> / r1 7 ! .. 74 — lir :� t <br /> I 11 . WASTE DESCRIPTION- 12. Containers 13. 14. <br /> Ii No. Taal Unit <br /> Type Doughty WWol. <br /> a <br /> I <br /> 1 <br /> G b, <br /> E <br /> E <br /> A <br /> T <br /> 0 <br /> W q d. <br /> h� <br /> yG, AONIional Description$ f/or Matarlals listed Above H. Handling Codas for Wsstas Eichel Above <br /> O Cc� p F <br /> es <br /> 16. Special Handling Instructions and Additional Interaction <br /> 0 <br /> � t <br /> ". �6 aao -d - <br /> 10. GENEHATDA'SCERTIFICATION: Iherebyc dlfyllhatlha lontsoflhisshipnientareluily d accurately described and are in an mspccts <br /> �.' -`- in Proper condhlon for transport The materialscla ribed on this manifest are t subject to federal hazardous waste regulations. <br /> Dam <br /> PrinlerliTyped Name Signature Mpnth Day Year <br /> NJV. Transporter 1 Acknowledgement of Receipt of Malarial& - Datx. <br /> A Pflnletl/Typed Nema Signature -. <br /> N AAan(h - Day Year <br /> s � NS f ' tT <br /> p19. Transporter ? Acknowledgement of Receipt of MatelalS Date <br /> { T P��I Iced(Typed burroI Signature M In Day Year <br /> F 19. Discrepancy Indication Space -- - <br /> A <br /> C <br /> 20. Facility (timer or Operator, Candicallon of receipt of the waste materials covered by this manifest, except is noted in dein 19. <br /> _ TPanic Signature <br /> IITyp tl NamoM th D,Y Year <br /> o / �} / t <br /> tl <br /> F-1d 02002 1: 3EAASTERO (800) 821-6008 vmw.labelmesler.cgn w0NRvXNavuaa � ,� RN43195 <br /> u�Na lsaavtlelN lnrc (L� SDY_NY. . _ <br />