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(Form yuee cn e'(2 ' �� <br /> NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest Doc.No. 2. Page 1 <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address hA <br /> 4. Generator's Phone((!:t% <br /> 5. Trartrtmpany Name 6. US EPA ID Number A. r s P e <br /> 7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone <br /> 9._Designated <br /> Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> - 11.Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WWoI <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A c. <br /> T <br /> O <br /> R <br /> d. <br /> i <br /> D. dditional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 15.Special Handling Instructions and Additional Information <br /> 16.GENERATOR'S CERTIFICATION ce ' the materials described above on this manifest are not subject to fed- r gulations for reporting proper disposal of Hazardous Waste. <br /> Print yped Nalne c on D Year <br /> gQLJ <br /> ti, S <br /> TR 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> N Printed/Type me Signature Month Day Year <br /> 1 01 <br /> S s b a <br /> P <br /> R 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printed/Typed Name Signature Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <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 Y. <br /> Y <br /> Printed/Typed Name Signature Month Day Year <br /> Printed by J.J 1d:LLER 8 ASSOCIATES INC. § " t y - "T <br /> Neenah,wi s4957-0 YNE ,x..» 4 UPC5 Rev. 12/98 <br /> ORIGINAL-RETURN TO GENERATOR <br />