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I <br />NON -HAZARDOUS <br />1. G`enerator's US EPA ID No. <br />Manifest <br />2, Page 1 <br />WASTE MANIFEST <br />Documei,t"o. t.1,< •, 9113 <br />6 .r,. <br />of I <br />3. Generator's Name and rtailk,g Address <br />llRdlr:7bl t>h�IFEt; 12�ti1..}.t)r� <br />:=- f)Nt7(s7 ` <br />1311", ENV 01'r IR <br />I -c,(3 T mill... tai <br />4.0 OW"A <br />CA fl51t; <br />} nri' F <br />S. Transporter 1 Company Name <br />6. US EPA ID Number <br />A. State Transporters 10 <br />; LstJii'i' I;P VI}it�t�Pai t} tAl <br />;;rift/I�G0 02 fi 17 7 0 3 u <br />B. Transporter 1 Phone ift(}Il}<l7t- t<i35 <br />7. Trepsporler 2 Company Name <br />8. US EPA ID Number <br />C, Slate Transporter's ID <br />D. Transporter 2 Phone <br />. ,9. Designated Facility Name and Sde Addre <br />10. US EPA ID Number <br />E. Slate Facility's 10 <br />1)P_MENI'l0 / Kr11()O On <br />WO F}. Al;ti;i ;OA Y iiE . f1. <br />F. Facility's Phone <br />C.Ci i it)Plf <br />GA `?0222 t f;.'i' cr � +� (l i 3 ; J.. <br />11:.WASTEDESCRIPTION <br />12. Containers <br />13, <br />14. <br />No, <br />Type <br />Total <br />Quantity <br />Unit <br />VA./Vol. <br />N't74,1 M.-A};i71'MS AST;,.fir:/i.lt) <br />.UAL <br />G <br />b. <br />E <br />N <br />E <br />R. <br />c.. ,. <br />A <br />T <br />O <br />R <br />d <br />- <br />i'.'liadtioharoe-scrtptron"e ror§ veic�d - <br />' e' . r- --'-• .. _ = .. .. <br />H�ienCnng cones riSr wastes Ustefraliave' �.. ,�... • . , . <br />-IS, Special Handling instructions and Additional <br />Information <br />- ... ... - . . <br />l -.f IERGOCIY t:O MOT : 01 <br />Rvf REQ% 4M -93C0 " Fi-,'OFILl-. Y iR� -1 : W9131 "()IL " PORI AlI(Mi 1.50 4 AIPP 1Zt.}PRIA T h <br />1'IaR` C}I�ht.: (�ttCi f t tr l l'V ; CC, <br />1J1PN4r;lq i <br />t <br />"AWW <br />tl �A*/.///fes,/,///AW® <br />18. GENERATOR'S CERTIFICATION: I hereby <br />rtity that the contents 011hIs shipment are fully and accurately d scribed and are in all respects 1 <br />In proper condition for transport. The ma <br />described on IFJs manifest ere not subject to federal hazardous aste regulations. <br />Date <br />Print ed Narrlpl �j <br />! <br />Sigiteture % , /•. <br />! <br />i J/d`ojr)11, D y� Ygar.: <br />a <br />e !/ <br />CJlf r' f <br />Iii✓=` <br />' <br />A. <br />�'� <br />T <br />17. T nsporter 1IAcknow ement of Receipt <br />r materials , r <br />Date <br />N <br />Pdrll YP� N /!} / /� <br />f <br />S1,970ie <br />P <br />?4 <br />\ <br />` <br />0 <br />18.'Transporter2Ac"whkpmenIDIReceiptctMaletiaN <br />L.---�•� <br />E <br />Dale <br />T <br />PrintedrrypedNama <br />Signature <br />-7 <br />AbnN Day Year <br />E <br />A <br />.1 <br />19. Discrepancy Indcatian Space <br />F <br />A <br />C <br />t <br />20. Facility Owner or Operator, Certification of re4 <br />elpt of the waste materials covered by this manifest, except as noted in Item 19. <br />L <br />! <br />Date <br />T <br />PrintedrrName <br />S!gnature <br />Month Day Year <br />