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NM AZARDOUS WASTE M' ANIQT fifrl <br /> Pie se print or typo jFrjrrn designed for Use on elide .fypewdlev) <br /> (,2 pitch) <br /> NON-HAZARDOUS Woralar's US LPA 16 Nf.), <br /> Manifest ".Page'I <br /> WASTE MANIFEST Der"umfol!No. <br /> -7�Genurator's Narneand Mailing Address <br /> t <br /> 19-37AC <br /> 4.Generator's PlionC <br /> 6.Transporior I Company Narne ply 6. Uq EPA 1"D N'u'mbe, I:il A.Wale Transporter's ID <br /> 13.TrwisponeT 1 Phone <br /> 7,Transporter 2 Company Name <br /> US EPA ID Numhor <br /> C.State Trarispoiws in <br /> D.Trwispoftof 2 Phone, <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Numbertf Scale Facility's 11) <br /> I ge-6-f ky <br /> AJF.Facillty'�q Phone. <br /> V <br /> 11.WASTE DESCRIPTION <br /> 12, Containers 13, <br /> 14. <br /> Type Total Unit <br /> Qoanlily Wt.NGI. <br /> ,OJOAJ d#4rAP_ 0(9_s <br /> E <br /> A Rr. A)OAJ L_1 42%j it <br /> T <br /> 0 <br /> R & <br /> Lu <br /> ol vulv v"Y <br /> Ir <br /> G.Additional Descriptions for Malefials Listed AII v H.Handlirg Codes for Wastes LisiLd Above <br /> (n FE 9 1 <br /> D <br /> 0 <br /> ;5.Spatial Handling frisiruclions and Additional 41tormallor <br /> (7 ;001�3 qs,2 1 <br /> 1)A0V _ 0 90-7 <br /> 4 , 55- t,2 <br /> ) <br /> 30 -2) A DL; <br /> _s, e or. <br /> Z 7 -.705- <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment ere ftjll�and accurately d09Cr+bdd and are in a1€ruspecls <br /> in proper condition for transport.The maNmoir doscribe.d on this manIfLst are not subject In ltiyardou,w1ran. eegUlat!Oos. <br /> ii <br /> Date <br /> Prinied/Typed Nome Siq;),.lure if <br /> Month Day yoa, <br /> r �ZIgm- LILLOA <br /> TR 17.Transporter I AcknowlodgemDol df Receipt of Material,,,, le <br /> Ualo <br /> ?7 <br /> A Pri7dlT ed Name Sign,1 re <br /> N I , w <br /> Month Day Year <br /> S Im�Iv/,Z It <br /> P ;;;v4 - - . I- a-b- <br /> 16.Transporter 2 Acknowledgement of Receipt of MatunalS Date <br /> T Printed/Typed Name Signature. Month ay Year <br /> E <br /> R <br /> 19.Discrepancy Indication Spare <br /> A <br /> C it 1 <br /> 20.Facility Owner or Operator:Certification of receipt of the waste materials covered by this manifest.except as noted in item 19, <br /> I. Date <br /> "f f Narne Signature <br /> Monll? Day Year <br /> ot 113 tz? <br /> FA402002 <br /> LME (800)621-6808 www,labe$mAster.com PRINTED R Flov.3195 <br /> U31W SOYBEAN INK <br />