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i � } <br /> ti NON-HAZARDOUS WASTE MANIFEST <br /> Please print or type (Form designed for use on elite 112 pAch)typewriter) <br /> NON-HAZARDOUS 1 Gene tots US EPA 172� Manifest 2 Page 1 <br /> WASTE MANIFEST ( � / Document No <br /> f 4 1 of <br /> 3 Generators Name and Mating Address {, <br /> { it t3# fAZ r RAI''Wft tTe 111!1 Tt?ti*, RA 9605!? <br /> �'1 0[79'C()W, C& ��e 2 /q AT'CN %MTT TT 1110MI;91 <br /> 4 Generators Phone{ <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A State Transporters ID <br /> ii i 1 !.111111 GiPn ft1)l1V r'tV'FM .VIE 'T 1 f A 0 et Ii z '? - t 4 3 1 B Transporter I Phone <br /> 7 Transporter 2 Company Name 8 US EPA ID Number C State"transporters ID <br /> D Transporter 2 Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number E State Facditys ID <br /> air 01 '*T- ",s ZL t <br /> 208-1 4�[Is C,4 b rJC., <br /> JE'_RJ ( <br /> ?.'Ul Pr13.0 d rfl 1A 44-)133 F Fac*tysPhone <br /> (;1Ii1) 324-1' <br /> 3tf <br /> 11 WASTE DESCRIPTION 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity WtNol <br /> a 190r4 if&I Sd1.2 f .1, (?f 34)L J f 5) <br /> G b <br /> E <br /> N <br /> E <br /> R C <br /> A <br /> T <br /> O <br /> W <br /> R d <br /> G Additional Desenptions for Materials Listed Above H Handling Codes for Wastes Listed Above <br /> to 1� <br /> O <br /> In 1 t,� <br /> a <br /> Q15 Special Handling Instructions and Additional Information <br /> Jiv, 'ptut r ( "PlIA Ir'r R� it tlt fit 7ti�t 1r(i r a!«111 <br /> _ 113114 11111 0041 eve 11'3 Ji-4'l <br /> Z tY)%: VRMaf[(10111 111 0117T F' <br /> %W-JW AV AV AV " AW AW AW AV AV W AV AN AWz <br /> 16 GENERATOR S CERTIFICATION I herel>�certrfy that the contents of this shipment are fully and accurately desgnbed and are in all respects 1 r <br /> in proper condition for transport The materials described on this manliest are not subject to tede(raall hw/a$te regulations <br /> \ l" - /) Date <br /> 0 rPnnied(Typed Name Signature <br /> s I'I I i s'ARD fit-1j t11.1r ea <br /> R 17 Transporter 1 Acknowledgement of Receipt of Materials L <br /> i bate <br /> N Pnnted(Typed Name Signature �/ � ��w Month pay Year <br /> S �A U L onl D��iS <br /> P <br /> O 18 Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R PnMedlT <br /> T Yped Name Signature <br /> Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> 1 <br /> 20 Facility Owner r Operator Cerlification of receipt of the waste materials covered by this manifest except as noted in Rem 19 <br /> L <br /> 1 I Date <br /> T P YPed Name Signatu `1 month DaY Year <br /> Y 01-1 1 021 <br /> CF14 ®2002LA • <br /> pELMASTFA® {60016213808 wwwrabelrmagtercom <br /> u�sanr�.+ � egir <br />