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I <br /> NON-HAZARDOUS 1• Generator's US EPA ID No. Manifest 2. page 1 <br /> Document No. <br /> WASTE MANIFEST :. ,. r : . r� . , t of <br /> 3. Generator's Name and Mailing Address <br /> 4. Generator's Phone(r"•, £ ) I r i,,w <br /> 5. Transporter 1 Company Name 6. US EPA ID Number y // i <br /> _ :, ,.�( Z <br /> `i rF' Imo' i '.: ' .�} .�.r rffL!�-. `75- 161 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number A. Transporter's Phone <br /> B. Transporter's Phone <br /> �C .1 e.;�,1'jw '' 4J 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 /> —�_- <br /> L` i• <br /> E <br /> T <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 15. S eciol Handling Instructions and Additional Information - <br /> k,Ult . D Y '^ice <br /> 16.GENERATOR'S CERTIFICATION; 1 certify the materials described above on this monifesi arg not subject to federal regylations for reporting proper disposal of Hazardous Waste. <br /> Printed/Typed Name Signature _ _ Month DJay Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials s <br /> A T a <br /> A frated/.y d N mel %: $i nat a .r _ Month Day Year <br /> v" 4; <br /> P <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> YPrinted/Typed Name Signature Month Day Year <br /> E <br /> A <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br /> 1 <br /> T <br /> Y <br /> Printed/Typed Name Signature Month Day Year <br /> GENERATOR'S COPY <br />