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NON-HAZARDOUS 1 Generators US EPA ID No Manifest 2 Page 1 5S*F <br /> 7,3 )YMTE MANIFEST A ` QC)0 04- �3 Q f a of 1 1 3Z r7137- <br /> 3 <br /> Generator's Name and Mailing Address VQ� <br /> 4 Generator's Phone(�f♦D ) 5-7 <br /> 5 Transporter 1 Company Name b US EPA ID Number <br /> E o <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 /> jPiSpo8 Transporters Phone <br /> -it, 4.7eP..Qo Q:1 �V p` C Facility's Phone <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 <br /> Total Unit <br /> No Type Quantity Wt Vol <br /> a <br /> j U� <br /> G b <br /> E <br /> N <br /> E <br /> R <br /> A c <br /> T <br /> 0 <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 described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> P""0rit/Typed NameSignature Month Day Year <br /> �EF7 qt4 1�0� t<t� S� �� 1 <br /> T 17 Transporter i Acknowledgement of Receipt of Materials <br /> 1111 <br /> A Printed/Typed Name 9 <br /> Si nature M nth Day Year <br /> 'e, -45R <br /> N <br /> S <br /> 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Dar Year <br /> E <br /> R <br /> 1Y <br /> 19 Discrepancy Indication Space <br /> F <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except a&Aoted in Nem 19 <br /> I i <br /> T <br /> Printed/Typed Name Signature <br /> Month Oar Year <br /> GENERATOR'S COPY <br />