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• <br />1. Generator's US EPA ID No <br />Manifest <br />2. Page 1 <br />NON -HAZARDOUS <br />, <br />WASTE MANIFEST <br />r r ,,.., -L <br />:,.rti <br />Qocumeftt Q 0. <br />I :._, '_, <br />of q <br />r <br />d.. <br />3. Generator's Name and Mailing Addre1ss <br />7 T H, <br />,y4aLj, <br />ir..j{..;.r NI CA 9620b <br />n:1 <br />4 Generator's Phone <br />5. Transporter 1 Company Name <br />4 <br />6. US EPA ID Number <br />A. Transporters Phone f' <br />j NI -i ED l`:.lh,'IF`}t, 6 :�t'�t:r}; <br />ir..}t' C,ta. U 1) .7 9 ', 7 .7 <br />7. Transporter 2rCompany Name <br />8. US EPA ID Number <br />B. Transporter's Phone <br />9. Designated Facility Name and Site Address <br />10. US EPA ID Number <br />C. Facility's Phone <br />CCtAAME-RCIAL FIG.TE F�; REwYC <br />INN <br />11. Waste Shipping Name and Description <br />12. Containers <br />13 <br />14. <br />Total <br />Unit <br />i <br />No. Type <br />Quantity <br />Wt/vol <br />a., <br />j''d{)N HA_Ihii: r_ i D'..1 .'.. VV C—Z Th _. 1. <br />t <br />(DRAINED l%`. -i;,. <br />G <br />b. <br />r' <br />E <br />Nl <br />R <br />c. <br />A <br />T <br />O <br />u, <br />R <br />d. <br />D. Additional Descriptions for Materials Listed <br />Above <br />E. Handling Codes for Wastes Listed Above <br />t. t.,t,r:sf�1�LJ is 1�:C' +:�L. F!t.."r.E•f <br />,� ,1..:.7F�? r: <br />�' <br />15. Special Handling Instructions and Additional <br />Information <br />.,Q.'HP EH+EIte. E14i <br />b2. t'i,: '-L?>:�.i '_��2 G ti'lar..AR J:, k>F'f-+::'�? (i.r."J'�: %'�i'C.''��'k:.j_�. •.:. V t. t.. ,;'1�.,. Ylvlk;iq :' <br />`:5, <br />TT$,M <br />�uF <br />Aw <br />16. GENERATOR'S CERTIFICATION: I certif <br />the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br />Printedffyped Name <br />Sign4ture :. Month Day Year <br />s! <br />T9j1 <br />�_i. a f� <br />€-ir�d 4.' .�� ._. .... <br />R <br />17. Transporter 1 Acknowledgement of Rece <br />pt f Materials <br />APrinted/T <br />N <br />S <br />Printed/Typed <br />ed Name <br />Signature Month Day Year <br />`.� @ <br />O. <br />R <br />Transter 2 Aeknowled a nt ece' <br />por <br />pt o aterials <br />.' <br />T <br />Printedffyped Name <br />Signature Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />20. Facility Owner or Operator: Certificatioi <br />of receipt or waste materials covered by this manifest as noted in Item 19. <br />t <br />Y <br />Printedffyped Name <br />Signature Month Day Year <br />--------------- <br />---------- <br />GENERATOR'S CORY <br />