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w . <br /> Rlk,ase prini or type.(Forw designed for use on E.,Ne(t2 pitch}typevvritrr,r.} <br /> NON-HAZARDOUS Of=raa r 7 Vumher ?.P2lF:I o :i,-n:eraency Res„o ase Phoec 4,Waste Tracking Number <br /> WASTE MANIFEST <br /> Gener;i;or' N�mis and t ia:.ing AddFcss Genaralnr's C'rc ,r,icress i,if d,'�"e��nt:rr:n r)aidiig address) <br /> Generators F'lorc <br /> &Transporter I :om1.jiny'J,v-; U.S.LPA ID A'uTo,er <br /> i <br /> 7_Transporter 2 Gumpacy'J:;v�; — — — l.S-EPA ID Number —— <br /> &.DeJgnated Facility Nems' iu:J S I AHdr;;; U-S_EPA ID Number <br /> Fwjlitv's Phone: <br /> qa 9b.U.5-DDT Destriptlen iinc!uding Pfri'l*i Snipping Name,Hazard Clnss,ID Numur�r_ ii"; Cont�v ws -1 Total '2.Unit <br /> H':; ar,c?at,k'Ing G'Cup(if 317y1) tin, Type Gua^'.�y :1+'.,JVol <br /> i. — <br /> f� <br /> O <br /> LU <br /> U <br /> 3. <br /> 4. <br /> !I.Sperial Handling and Addtrrlal Infcrmai:on <br /> I <br /> 14. GENERAT-P",,17R'flF;CVi li I Certify the materials described abore on this manifest are no!suh'lect to federal regulaliens`or reporllcq proper disposal cf Hazardous'Alaste- <br /> UenErato h.Sonth I Day I YFar <br /> ;n':a: �f71�1'FS(lf1t5 � i <br /> H Y ❑! d n iJ c. _'PD'i frpm','.S, Port or ti�lfryie%It: -- -- <br /> " al ruiature(ft;r��yf,&tsonly; Date lemving'US_: <br /> Of <br /> rl,i ;rb:i,nlent of Rec;int 0i to-'raterals — <br /> [1_! <br /> Signawrc Month Day Year <br /> O <br /> 0. <br /> Cn <br /> Trane.dib _F`i ,.' 1 ::,J iJ.0 C S.Pin morth Day Year <br /> � r <br /> 17 F <br /> F— <br /> :sidwr P lal Rejection ❑Ful.Rejection <br /> 3 171).Aiternaain Fic.d::cicrG•n.r;itnrl — — — <br /> F-- _ IJS.EPA ID Nu!rber <br /> U <br /> Faeiitv'6 Phrnne <br /> 17c Si,nalurerf,Sgei��ateFsnillty;crC:a��e:atorJ Month Day Year <br /> Q <br /> q <br /> Cir) <br /> n <br /> LLi <br /> D <br /> i 8 Dusxll heat=ac:Iify Qwl ger ur Operatar:Cer!ificatlun o mraip',rf'.1ater;als covered by the manlfa_st axcepi as notes n;iia 172 <br /> P`nta,,.Typtd Name Slgnauru Month Day Year <br /> -NHM-C-C-91 <br /> 6-GENERATOR'S INITIAL COPY <br />