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"s�IBB9 a tl 7 fV <br /> NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest a est Doc.No. 2. Page 1 <br /> WASTE MANIFEST . . . . of <br /> 3. Gen ator's Name an aili g Address <br /> L- eF lzl� wa L— <br /> 4. Generator's Phone <br /> 5. Tr s rterr mpany Name 6. US EPA ID Number A. Transporters Ph. e <br /> 67 <br /> 7. Transporter 2 Company Name 8. USE A ID Number B. Transporter's Phone <br /> 0 <br /> 99. Designated Facil' Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> 11.Waste Shipping Namk and Description 712. Containers 13. 14-Total Unit <br /> . Type Quantity Wt/Vol - <br /> a <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A c. <br /> T <br /> O <br /> R <br /> I d <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> i <br /> 15.Special Handling Instructions and Additional Intonna'on <br /> 16.GENERATOR'S CERT] ATI the materials described above on this manifest are not subject tot deral regulations for reporting proper disposal of Hazardous Waste. <br /> Print yp n Da d Name reYear <br /> TR 17.Transporte Acknowledgement of Receipt of Materials <br /> NPrinted/Typ Name Sign atu e n Month Day year <br /> S © tJ <br /> P <br /> R 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printedrryped Name Signature Month Day Year <br /> IR <br /> 19.Discrepancy Indication Space <br /> IF <br /> A <br /> - C <br /> 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> : T <br /> Y Printed/Typed Name <br /> Signature Month Day Year <br /> Pdrrted by d.X KELLER&ASSOCIATES INC_ r 3 ' r 4 ' ' <br /> Neenah.VVI 54957-0368 g, - e 1r <br /> 14 _11 <br /> A2 BLS-CS Rev. 12/98 <br /> ORIGINAL—RETURN TO GENERATOR <br />