Laserfiche WebLink
40/15/97 09:59 %T707 746 8297 ALL WASTE 004/004 <br /> NAMPO, <br /> NON-HAZARDOUS 1. Generator's US EPA ID No. Monife.f 2, Page I <br /> WASTE MANIFEST Document No. of <br /> 3. Generator':Namc and mailing Address <br /> 4. Gent-rotor's Phonc <br /> 5. Transporter I Company Name 6. US EPA ID Number <br /> . <br /> ."!; — <br /> . 1 e �! .1-1— z; —C_:� <br /> .1. 4 <br /> 7. Transporter 2 Company Name a. US EPA ID Number <br /> I . . . . . . . . . . . . <br /> 9.' Designated Facility Name and Site Address 10. US EPA ID Number A, Transporter'-.Phone Y <br /> B. Tran-.porter's Phone <br /> C. Facility':Phone <br /> 11. waste Shipping Name and Description 12, Containers 13, 1 A. <br /> TOW Unit <br /> No. Type 0.anTiTYWt Vel <br /> a. <br /> G b. <br /> E <br /> N <br /> E <br /> R <br /> A <br /> T <br /> 0 <br /> R <br /> D. Additional Descriptions for Material;Lisrcd Above E. Handling Codes for Wastes Listed Abo-e <br /> 15, Special Handling Instructions and Additional Information <br /> 16.GENERATOR'S CERTIFICATION-- I cem;fy ihn rol.eriNl, described abo-e on 1h;- ln.nlfelf are no, wbjvct to fedecol..regulofloma for reporting Proper disposal of Hazardo-wov.. <br /> AA—Th Day.. Year <br /> Prigyad/Typed Name <br /> T 17.Tra—portcr I Acknowledgement of Receipt of Moier;als <br /> R <br /> A, Printad/TXjped Nam; Sign M Ph Day Yc r <br /> _x 2.Y <br /> Signal <br /> *N- , <br /> S <br /> P <br /> 0 IS.Trom'spor'ter 2 Acknowledgement of Receipt of Materials <br /> mT Printed/Typed Nome Signature M.P,,h Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L20,Facility Owner or Operator:Certification of receipt 01 _QSje materials covered by this manifesT except as noted in lfcm 19, <br /> 1 <br /> I <br /> Y Printed/Typet,N ame Signature I I AA.nIh Day Year <br /> :A <br /> GENERATOR'S COPY <br />