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1. Generator's US EPA ID No. Manifest 2. Page 1 <br /> NON-HAZARDOUS Document No, of <br /> WASTE &AANIPEST <br /> 3. Generator's Name and Mailing Address <br /> 4. Generator's Phone <br /> 5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone <br /> 7.,Transporter 2 Company Name B. US EPA ID Number B. Transporter's Phone <br /> 9, Designated Facility Name and,Site Address 10. US EPA ID Number C. Facility's Phone <br /> 12. Containers 13. 14. <br /> 11. Waste Shipping Name and Description Total Unit <br /> No. Type Quantity Wt Vol <br /> a. <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: 1 certify the material.described above on this manifest are not mblact w federal mgularioru for reporting proper disposal of Hp[ordoas Waste. <br /> Printed/Typed Nome Signature Month Day Yeas <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Nome Signature Month Doy Y7 <br /> N <br /> S <br /> P 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <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 Printed/Typed Name Signature Month Day Yeor <br /> 'C/SID/FCOPY <br />