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NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 <br /> WASTE MANIFEST Document No. of I <br /> 3. Generator's Name and Mailing Addre ` (TE-0 <br /> 6 A-$-'4� ll..J C-,�4r si - l`✓ _ <br /> ` 'l <br /> 4. Generator's Phone( ) ' o"CID CA- <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone <br /> F((-.r� l�+�% fr S 9 cl 1 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 9. Designated Facility Name and Site Add ess 10. US EPA ID Number C. Facility's Phone <br /> r�j L_TL'2a- v-rcy c04Q <br /> 10 LjIrKAMn Aof <br /> CZIvW)1)11 )" '5119-x-2(c. 44.4:$I <br /> 11. Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quanti Wt Vol <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> T FILTER RECYCLING SEM'/lC;�St RIALTOFACTI..I ' EPA <br /> R #�.t�tD.•t J i'HE A !',�p'd,ii .iYi" !':L,y'.a ii' li:;i a r•t`...? <br /> d. <br /> D. Additional Descriptions for Materials Liste Above E. Handling Codes for Wastes listed Above <br /> ('4j -Iw- . /V/o <br /> C CSI L <br /> 15. Specia Handling Instructions and Additio al Information <br /> A <br /> i( ) wAT TL-M_ <br /> 0 2z)j 2s <br /> 16.GENERATOR'S CERTIFICATION: I certify t e materials described above on this manifest are not subject to federal regulations orting proper disposal of Hazardous Waste. <br /> Pr' ted/Typed Name Month Day Year <br /> r4�yjyv Signat re a ©• <br /> Tq 17.Transporter 1 Acknowledg ment of Receipt f Materials 17 <br /> A rinted/Typed Name k Signature <br /> N —7 <br /> ` - j Mont Day Year <br /> P \ `/ 4 D <br /> R18.Transporter 2 Acknowledgement of Receipt f Materials <br /> T Printed/Typed Name Si nature <br /> E g Month Day Year <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L 20.Facility Owner or Operator:Certification of r ceipt of waste materials covered by this manifest except as noted in Item 19. <br /> 1 <br /> T <br /> Y <br /> Printed/Typed NaAs Signature Month Day Year <br /> ORIGINAL-RETURN TO GENERATOR <br />