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i <br /> _1144N HAZ�#RDOUS WASTE MANIFEST <br /> h gpepr)ntort p j r (FQirrndeslgned-far.usebnelite02p1tcti}fype,{rul <br /> - <br /> € '7 fNOIV�HZ ;RpJ�lS » t tienarator a Lis EP51dlo is 1` ' Nlanuest <br /> i rte_TitNo, <br /> Pao t f <br /> YY� T.�s1V114� G.S Dopilmant No of <br /> 1 <br /> ty5.��Trensporterl Cofi�par�' oma ' B {C- Itl�'EPA>1D�Number A S4utaTrensparterslD F - <br /> ��ryry■+ >1 9l <br /> .�., .. B TransPorter'°i Phone _ <br /> a <br /> - ��7.Transporter 2 CamparryName - � � ` r °US EP 41D Num r� -- 4 J � <br /> • - _- ,: .,a -.�:.., . .,- .-, �' rart9porter 2 P3aorte <br /> _ bT <br /> -�9:rDeslgne Faatity Name And SRa Address _ _t �0 f. --,r IYSi f'A'Ib Nur i J E Stage FacIl3t 6 D; r <br /> DESCRIPTION ..y 12 Odnlafriars *`. 'f` <br /> 'Ta!al <br /> , No. . 'Type QuanOty ry:'WLAfoI <br /> :. trsn >iE .00. Ax , 001 Cuttsna3 <br /> 3L`tT 5 ' <br /> C. <br /> W d. f r f <br /> 1 <br /> " G.AddMbnal DeserERtlolis rot Materrelsniistad J b&e ; H k�ntlttng cad afar Wastes Llste�Above i a p <br /> ,e• 15 SpedaL1,' andling Ins an ddRl6nal InFnrma an i <br /> • �//q 1 a,�j;M }yV _ u/� ('}M( 1 �y 4J .. ��j2�,','.- ,,�ppx far J <br /> t&GENERATOR'S CEFMr-7CATSOTF I hermdb6yycahlly that the contents of tld9 shlpmern are fillty and amiraiety descdbed and are M a0 raspecisIn proper condition for trsnspoh.The materfafs described on this manifest are not subjem to federal r{eraidaua waste regulations. <br /> Date <br /> PrintadlTy�ed;Name.. 51gnaNre :'{; .. Month '. Day Year <br /> �ty :17 Tmnepviter 1 Acknowladgsmenl.ol Receipt o1 Materials - t '� ' D e ,,� • <br /> - .fyl1�1 P.rin d!f d Nama' aSlgngture a�ol. ,.-.x.� � �;.:.�...�. �-�,,.: �•' - 'Morffh �Dey )t3Year� <br /> p" 1,8 Transpoger 2 Acknowledgement of iiecelpt of Materials Da <br /> A r. <br /> NT11 d/T Name -. - _ -- ° - . <br /> yped '� 1 y� � � Signa{Jre� x r M1lonllr Day-r�Y 'r : <br /> i <br /> C a,1 <br /> { <br /> 1 520 Faclll t]wner or O erator•Ce'floation df race t oT the Wake materists wv6red this enI - 1• <br /> � ty p' rq IP �6y ni• fest,eJa�pt as noted In)tem <br /> 1 r _ Data , <br /> 'PdrdedrTyped Name - Signature - - '. Mapth bay ..Year <br /> ;'CFi4 02002 ds(800)02t-5008 w .Iabeknastar.can' ® lsnmw mi.�l <br /> 94riwu <br />