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NON-HAZARDOUS 1, Generator's U5 A D No. M t floc.No. 2.�age <br /> WASTE MANIFEST 0' . !°f <br /> 3. Generator's Name and Mailingdr <br /> n <br /> fc 0y? G <br />' 4. Generator's Phone <br /> Tr port Company t�e �` fi. US EPA ID Number A. Transporter's Phon <br /> 7. Transporter 2 Company Name t a. US EPA ID Number B. Trans`porter's Phone f <br /> 9. eslg ated�FaciEity N me an a Address 10. US EPA ID Number C. Facility's Phone <br /> 11.Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. I Type Quantity WttVol <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A c. <br /> T <br /> 0 <br /> R <br /> d. <br /> I <br /> D. diti>,na{Descriptions for M te�Above E. Handling Codes for Wastes Listed Above <br /> 15 pecial Hand�strudions and Additio al lr} nio�rm 1io n{� n � <br /> V"Cly' l7Tf—mss` f ue C f Y\ <br /> , <br /> 16.GEN ATO CEFrnFlqAT10J 1 oe",Wlerlfedlescribed above on this manifest are not subject tq fe eral regulations for reporting proper disposal of Hazardous Waste. <br /> d �a ure t. onth a <br /> r�h\.J,I <br /> TR 17.Transpo 1 AC o e gemen of Receipt of Materials <br /> A P inledlTy a Signa r MOp4f2 Da <br /> P <br /> OR 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printed/Typed Name Signature Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> C <br /> 0.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in item 19. <br /> V <br /> Yped Nam � Signature M050qay re <br /> inn.�srmss y Z B S,C5,Re . 12!98 <br /> " <br /> ORIGINAL — RETURN TO GENERATOR : <br />