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i69-csLG-u u 1U4913 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR <br />NON -HAZARDOUS 1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone f <br />4. Waste Tracking Number <br />cc}y <br />Y/ASTE MANIFEST GAjZ000 5 <br />! <br />7 <br />i_ Generators Name and Mailing Adaress Generators Site Address Qr different than mailing address) <br />JIf K Enol`—dr'n tanto. -1 <br />75's7 Corr -(.Io avt. <br />Pltorte: p . <br />Generator'sTrac Ca. Sao <br />6. Transporter 1 Company Name <br />U.S. EPA ID Number <br />J t 2 En ✓unn�t�l _ <br />6 <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />B. Designated Facility Name andel SiII Address eG(, }/G I rn �hC . <br />!11 at r <br />U.S. EPA ID Number <br />yY� 0 6f4o#4 Dr. Sf G So <br />Facility's Phone: �� raruc�l D • �a , yS� 3 Sf 9/6 6 / -.-7ao <br />9. Waste Shipping Name and Description <br />10. Containers <br />11. Total <br />Ouant,!y <br />12. Unit <br />Wt Not. <br />No. <br />Type <br />' Ezluva ,eccyc a c, M..ft-ftm <br />--- <br />0 <br />(LATEX <br />C <br />goo <br />L 6 <br />� <br />W <br />P <br />2 E��Cluded ?Zc y r -:obit, Wlxte-rral <br />3. <br />4. <br />i 13. Special Handling Instructions and Additional Information <br />14. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not sut>lect to federal regulations lot mponng pdisposal <br />of Hazardous Waste. <br />Generator's Offerors PhntedTyped Name Signatur <br />Joseph E, (/X <br />Month Day Year <br />J <br />1.- <br />15. International Shipments <br />11Importto U S. ❑ Export from U S Port of entry/exit: <br />— <br />Transporter Signature for exports only): Date leaving U S.: <br />ILL! <br />16. Transporter Admowletlgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name Signature <br />Month Day Year <br />'L <br />a <br />Transporter 2 Prinledrfyped Name Signature <br />Month Day Year <br />Ir— <br />17. Dacrepancy, <br />178. Discrepancy Indtcauon Space <br />❑ Quantity ❑ Type ❑ Residue <br />❑Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />J <br />17b. Altemate Facility (or Generator) <br />U.S. EPA ID Number <br />U <br />LL <br />Facility's Phone: <br />17c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />wW <br />IS Desxpated Faoarty owner or Operator. Certification Of receipl of materials covered by Lee manifest except as noted In Item 17a <br />Pr Typed Name t Signature <br />MOO Det Yew <br />i69-csLG-u u 1U4913 (Rev. 8/06) DESIGNATED FACILITY TO GENERATOR <br />