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N0 -HAZARDOUS WASTE MANI'rtST <br /> F Please print or type (Form designed for use on aria(12 pitch)typewriter) <br /> 1.GenarabYs US EPA ID No. Manifest 2.Page 1 <br /> NON-HAZARDOUS <br /> WASTE MANIFEST DocamentNo. of <br /> 3.Generator's Name and Mailing Address <br /> if <br /> i e.Generator's Phone 3(I.) 969-ro;`si'�' <br /> S.Tlanspwlafl Company Name ( 6. US EPA ID Number A.State Transporters ID <br /> ALIY3yii:��{.hieYllS4i'�f.7llyk}OS[�Sr:.1 I'1 i'�.ill(r r i1 t:j1.I B.Transporter l Phone V)S.4b-_1 )'::"+ <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Trnsperler's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and She Address 10. US EPA ID Number E.Slate Fadlity's ID _ <br /> Adlullf..GA Ci{eatirai Z"e,Ttt:Ipayi,il{c.INVA) '.rS.l.•i)`Nt) (}q.'i-i <br /> P65 pigg". F.Facility's Phone t '21 <br /> 11.WASTE DESCRIPTION Containers TSI U4. <br /> nit <br /> No. Type Quantity WlNaf. <br /> 1Vtea�+d 1:)t)'1.'isfi?t:;Cii.r\'D'�i3 ht:�'1'fstt9.r'tit. i.i.`.iUtl.i <br /> G e. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> G.Additional Desenptions for Materials Listed Above H.Handling Codes for Wastes Usled Move <br /> iQ 4">st>fiv Cl AP711TstiRf hr'OYt{ <br /> Ij <br /> 'O <br /> a <br /> 15.Special Handling Instructions and Additional information <br /> :Q <br /> N <br /> S <br /> Z <br /> O <br /> :z <br /> Off-MMEL Aff AW M AW AW AW AM AM M M AW AW AW AW AW AW <br /> 16.GENERATOR'S CERTIFICATION!I hereby certify that the contents of this sNpment are fully and accratHre <br /> ey described end ain all respects <br /> m proper condition for transport.The materials described on this manifest are rel cabject to federal haiardous waste regulations. <br /> Date <br /> Prinleelryped Name Signature _ +rAfoplA Day /Year <br /> T 17. Transporter l Acknowledgement of Receipt of Materials Date <br /> R <br /> N �PrintedfTyped Name 'yin SfgneWre Mme+" QaY, Y�r <br /> - <br /> P . <br /> O 18. Tranepader 2 Acknovdedgement of Receipt of Materials Data <br /> R Month Da Year <br /> T Pardled/Typed Name SigneWre Y <br /> E <br /> R <br /> F 19,Discupamy Indication Space <br /> A <br /> C <br /> 1 20.Facility Owner or Operator.Certihccran of receipt of the waste materials covered by this manifest,except as noted in ilem 19. <br /> L Date <br /> T Printed/Typed Name Signature hfonth Day Year <br /> Y <br /> CF14 ©2002 LLABELMASTERO (800)621-5808 www,labeiniaster.com <br />