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• <br /> NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST <br /> L <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than Mailing address) <br /> 4 <br /> -A <br /> Generator's Phone: <br /> 6.Transporter I Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and She Address U.S.EPA ID Number <br /> 44, <br /> ;sFN'K,A, I) <br /> Phone: <br /> _)2-233 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit <br /> No. Type Quantity VVt.Nol. <br /> 15- <br /> 493 <br /> L 8S <br /> 3. <br /> �-v4 <br /> 4. rs <br /> 13. Special Handling Instructions and Additional Information <br /> 14.GENERATOR'SCERTIFICATION:I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Generators/Offerors Printed/Typed Name Signature Month Day Year <br /> _j 16.International Shipments <br /> E]import to U.S. ❑Export from U.S. Pod of entry/exit: <br /> Tran orter Si nature for exports only): Date leaving U.S.: <br /> 6.Transporter Acknowledgment of Receipt of Materials <br /> ransporter I Printed/Typed Name Signature j Month Day Year <br /> J <br /> Transporter 2 Printedirryped Name Signatufe Month Day Year <br /> 1 t 17.Discrepancy <br /> I17a.Discrepancy indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br />