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I _ t <br /> I <br /> a NON-HAZARDOUS WASTE MANIFEST <br /> Please prin^or type (Form designed for useon 61ite 02 pild)"Writer) <br /> NON-HAZARDOUS 1.Generators US EPA ID No. Manifest 2.Paget <br /> WASTE MANIFEST Doc m¢ INa f <br /> 3.G¢neraftas Name and Mailing Address F-1`L — 'JI .-1Zj of <br /> L'L-ha OM <br /> a156 1 � �r^t'_ %d. tr. L <br /> 4.Generators Phone( ) L.2 4-L fii' C A. <br /> 5.Transporter 1 Company Name iC 6. US EPA ID Number <br /> A$tata Transporters ID ' <br /> B.Transporter t PMne <br /> 7.Transporter 2 Company Name 6. US EPA 10 Number <br /> ' O.Stile Transporters ID <br /> D.Transporter 2 Phone i <br /> 9.Designated Facility Name and Site ptldress 10. US EPA ID Number E.State Facility's 10 <br /> . "1 J4a gj(�yre EFanlilys Phone <br /> 11.WASTE DESCRIPTION .: 12. Contain¢m 13. 14. <br /> Total Unit <br /> No. TYPe, Ouantity WWOL <br /> F fesrvv�, 1©rJ <br /> - G n <br /> E <br /> ry i <br /> R C. <br /> A <br /> 7 <br /> O <br /> W R d. <br /> H <br /> N <br /> jG.Adnional Descrlptbthe for Materials Usled Aoove H.Handfmg Codes for Wastes Usted AOare <br /> o ( � K <br /> N <br /> IS..Spedal Handling lnetructions and Additional information <br /> Z I <br /> O <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby cenily that the contents of this shipment are fuh and accurelcly described and aro in all respects <br /> In proper condttlon for transport.The materials described on this manifest are not subject to Y¢deral haunfor 5 Waste regulations. <br /> Data <br /> PnntedRyped Name Signature ManM Day' Year <br /> T 17.Transporter l Acknowledgement of Receipt of Materials - Dow <br /> R <br /> A P'"`tl'n��yleMyped Nensro rl Signelure Monts .Day Vear <br /> It <br /> O 18.Traasponei 2 Acknovledgemenl of Repelipt of Materials Date <br /> RPrimedR ed Name <br /> T yp gn - Month- Day Year <br /> E <br /> E <br /> -t <br /> F g.Discrepancy Indication Space <br /> A <br /> C <br /> r t nil I nhemt <br /> r ntli ti f r I the waste materials mve etl this manifest.a as noted 1 B. <br /> 20,Fapt Owner at Operator;Ce w on o eu 1 o e I step <br /> y Ope P by <br /> L � - <br /> til <br /> T- PrIMcNTyped Name Signature' � Monts- Day vem <br /> F-1402002 LABUAASTERG (800)6215608 www.pradaaster.pap p -- Rev."5 F <br /> 1 <br />