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t r t <br />) <br />NON -HAZARDOUS WASTE MANIFEST <br />Pease <br />print or tyre (F(trm des,gned for use on elite (12filch <br />P ) t yPewritor) <br />N <br />ON-HAZARDOUS <br />Generator'sUSEPA 10No. <br />R c. <br />ASTE MANIFEST <br />0 0 o <br />t3 1 <br />Mandest <br />Document No, <br />erators Name and Mailing Address <br />r- <br />CnV1ron MCw I -C" <br />1 Carr,e,10 qacY <br />, c 4rators <br />Phone ( T31 ) ,53V - 3 L 9 Nporter <br />1 Company Name <br />US EPA ID Number <br />(bnrceYl tu- CCLr <br />[ne <br />A. State Transponees ID <br />CC)OdO J o qporter 2 Company Name6. <br />Transposer t Phone <br />US EPA ID NumberC. <br />State Transporters ID <br />nated Facility Name and Site Address <br />%'r 0 C' A , r � ez C�`n1-nLUS EPA ID NumbnrE. <br />narnGrti <br />D. Transporter 2 Phone <br />State Facility's ID <br />d Qt(a�4 A� d}` SO <br />�) L �S(� <br />1 J <br />F. Facility's Phone <br />11. WASTE DESCRIPTION <br />Containers 13 <br />a �!/ V f �.iV 1`-e'C'L/C )�-�I Izr ClT er-I L( rJ o. <br />�1I {� M 1 D <br />Total <br />TYF� Ouanh;y <br />W <br />F— <br />U) <br />Q <br />En <br />0 <br />Q <br />N <br />Q <br />O <br />2 <br />5 C F a,500 <br />G b- <br />) <br />E <br />N <br />E <br />R c. <br />A <br />T <br />O <br />R d. <br />G. Additional DesCnphons for Malenals Listed Above <br />H. Handling Codes for Wastes Listed Above <br />IS Special Handling Instructions and Addtional Inlormalon <br />16. GENERATOR'S CERTIFICATION: I hereby ceruty thrif tris contents of this sh'Pment are fully and accurately described and are in all respects <br />11 Proper condition for transport. The materials described on this manifest are not subject to federal hazardous waste regulations. <br />v ted'Typod Name r <br />n'llnrC J`- S� urs <br />R 7. Transposer t Acknowledgement Of Rece'Pt of Materials <br />A PrinteckTyped Name <br />N Signature <br />S <br />P <br />R 18, Transporter 2 Acknowledgement of Receipt of ii <br />T Printedi Typed Name <br />E Sgnaiwe <br />R <br />F 19. Discrepancy Indcation Space <br />A <br />C <br />L20. FauBty Ouner of Operator. Certification of receipt o1 the waste materials covered by this mandest, except as noted in item 19 <br />I nted•Typed Name <br />Y _r/ / r :::KZ <br />na <br />F' 02002 LADELI-'(ASTERO (800) 021-5805 ;vwv:.labelmaster.com <br />2. rags t <br />of <br />Date <br />RfooNr Da, ✓ear <br />/s 13 <br />Dale <br />Mom Day Year <br />Date <br />Month Day Year <br />Date <br />'dcmh Day Year <br />�sarltY1C <br />