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NON-HAZARDOUS WASTE MANIFEST <br /> Pleae p`dnt or type (Form designed for use on elite(12 Poor)typewriter) <br /> 1.Generators US EPA ID No. Manifest 2 of 1 <br /> NON-HAZARDOUS Doormen No. <br /> WASTE MANIFEST �' <br /> 3.Generators Name and Mailing Address / A 2 <br /> 1�1`9�ys"5 �E- B��k�Lk�t Rp <br /> 4.Generators Phone I ) S(MK W CA <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporler's ID <br /> 1 NSTks'T 1"C <br /> Ni B.Transporter 1 Phone <br /> ].Transporter 2 Company Name 8. US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> 9.Designated FFaaciility Name and Site Address 10. US EPA ID Number E.State Facility a ID <br /> cW. <br /> fam�+eM}� eeas- <br /> r 40 0�hbr, F.Facility's Phone .. � <br /> 11.WASTE DESCRIPTION 12. Containers El <br /> Unn <br /> No. Type ntity Vit NO <br /> a. <br /> S - <br /> Nonr I;�Z �o�L� IRIS D0.i�1 <br /> G b <br /> E <br /> N <br /> E <br /> R o <br /> A <br /> T <br /> O <br /> L <br /> R d. <br /> n <br /> Q G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> n <br /> r <br /> a <br /> S15.Special Handling Instivations and Additional Information <br /> z <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for l ansPort.The materials described on this manifest are not subject to fully <br /> hazardous waste regulations. <br /> Date <br /> Prinletl/Typed Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials _ Date <br /> R <br /> A PrinteNfyped Name Signature ��y Monty Day Year <br /> Ns tre <br /> p16.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R <br /> T Pnnted/ryped Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I W.Facltity Owner or Operator,Certification of receipt of the waste materials conned by this manifest,except as noted in item t9. <br /> L <br /> I 13ab <br /> T Priniecirryped Name Signature r� <br /> Monts Day Year <br /> Y /�i(c A IJHrrE�IEAt� <br /> F-1402002 ILMIELh1A5TEA6 (800)621-5806 wwwdabelmaster.com GI Rev.355 <br /> i cnvtur <br />