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NON�fAZARDOUS i.Ger eraror ID Ma ber 2 Page 1 d 3. <br /> WASTE MANIFEST t.:.".)l j'i�:•` '�.y." ]- ) ErtNr9y ReSpprtse Phone 4.Was1r hacking Number n <br /> 5.Generators Nana and Msa"Address 2 15 3 <br /> l R <br /> L' i8ir.�? ":E } Generators Silt Address(d dJterem than meling address) L i , <br /> /u fiiC."'fit .f.�:'-,w. :T` 7; :�. 1«�, "�y 7i rw*"'"•g,`1.:vwt£.J <br /> Generator's Phone �%•" .:C.'1. CA MNO ;:p <br /> 6.Transporter 1 company Name ,} <br /> AM' U.S.EPA ID Mallbef `1 <br /> 7.Transporter 2 CDnWy IN CAR=1 4333 <br /> ry,Na� d U.S.EPA ID Nanber <br /> S.Desigrgted,Facy'�: <br /> U.S.EPA ID NiNMN oar <br /> Fanhly'a plane; a tE <br /> .$11 <br /> 9a. gb.U.S.DOT Desaipgon(mchrdng Pmper S*pitg Name) 1g.Containers 11.Trial 12.Unit <br /> I p� (� f �R� No. Type <br /> ry» amity Wuwl. � fJ <br /> 0 f.. i-IYG.n:��Vi. u��W I rr kf 4�J <br /> W <br /> � z. <br /> 3. <br /> 4. <br /> 13.Speaal Handling InstrucionS and Additional Idermefon <br /> •sa; z 'i.. :7w q !'"z" rW:erc 'wrn r• u I rj, ,�, � r) 1�'.�hG <br /> r <br /> 14.GENERATOR'S CEFfiRCATION:I cediy the ma wi*dami)gd abD.e on ft mwaeg are not subjed to federal for reporting Proper disposal of Hazardous Waste. <br /> Gar'e'W. i ftWX �)+'_::re.n s✓9�""' i •.1r' Month Day 1¢ar '- <br /> 1S.nternaliaral Shipments p <br /> Transporter Sgnature{IDr ❑IffW to U.S. ❑Export ham U.S. Port d ehlrlead: gI <br /> w K Transporter AckninMedgemem of Receipt d Materials I DatU.S.: r"{ <br /> tr- WT i PrintaffWad Name Signature ter Day Year . <br /> 09 11 <br /> Z Tmruporier 2 PrintediTyped Name Signature rs <br /> Month Dal' Year ,$� <br /> 17.Dactepariq <br /> Ire Disaepamy Indcation Spaca Lj <br /> c>u>rxay ❑TYDe El Residue ❑Partial REe6or ❑FRec6Dn ' <br /> Mar*st Referenim Number; <br /> i76.Altertmte Facilly(or Generator) V.S.EPA ID Number ' <br /> J_ <br /> F <br /> LL Faclt' s Phone: <br /> = 17c.Skyratum d Alternate Facilty Or Generator) Mmdr Day Year <br /> in <br /> 2 1 1 1 1 1 <br /> j]] <br /> W <br /> O <br /> Is.Designated Faaliy Owner m Operabr;Certification of receipt or matedals w rod by the manifest except as noted In Nem 17a <br /> Pdnted.?yped Namet <br /> 169-OLC-0 5 11977(Rev.9/09) - •E <br /> TRANSPORTER#1 <br />