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� 5dt 41 <br /> NON-HAZARDOUSo TICA <br /> Generator's US EPA ID No Manifest 2 Page1WASTE MANIFEST cu L, Q a O O -A �'3 � � oment Nof / � �� 4 4--Z73 <br /> 3 Generator's Name and Mailing Address QU`V—�p 0 , 10 f ! i <br /> 4 Generators Phone <br /> 5 Transporter 1 Company Name 6 US EPA V Number <br /> cR-4C.+CsO 6 A C> Q 0014 (A43R <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number A Transporter's Phone <br /> 6 <br /> t� C)t L_ �t jj 8 Transporter s Phone <br /> 0 42:r- �"�' C Facility's Phone <br /> o Ct A �a42 {aa70 415 3fo�5- It <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity Wt Vol <br /> a <br /> g <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> d <br /> D Additional 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 I certify the materials descnbed above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed NameSignature ;^� _ Month Day Year <br /> :_f) �� <br /> ot- <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A P tedi/'TySped Name gnat . Month Day Year <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> E Printed/Typed Name Signature Month Day Year <br /> R <br /> LF <br /> 9 Discrepancy Indication Space <br /> 0 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br /> Printed/Typed Name Signature Month Day Year <br /> I <br /> TRANSPORTER #2 <br />