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'89'1 <br />e, 1, <br />k, <br />GENERATWS CC" <br />I. -Generator's US EPA ID Manifest <br />NON—HAZARDOUS No-_ <br />2. Page I <br />4 <br />ocu nl� <br />WASTE MANIFEST <br />of <br />3. Generator's Name and Mailing Address <br />4. Generator's Phone Ll <br />5. Transporter I Company Name 6. US EPA ID Number <br />Ij <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />. . . . . . . . . . . <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />A. Transporters Phone: <br />B. Transporter's Phone <br />V.. <br />C. Facility's Phone <br />11. Waste Shipping Nome and Description <br />12. Containers <br />73. <br />Total <br />14. <br />Unit <br />No. Type <br />Quantity <br />Wt Vol <br />0. <br />k_ <br />G <br />b. <br />E <br />N <br />E <br />R <br />A <br />c. <br />T <br />0 <br />R <br />d. <br />D. Additional Descriptions for Materials Listed Above <br />E. Handling Codes for Wastes Listed Above <br />15. Special Handling Instructions and Additional Information <br />L <br />16. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to f , ederal regulations for reporting proper disposal of Hazardous Waste. <br />_Ynted/Typed Narrre <br />ignature '7'-, <br />Month Day <br />Year, <br />Jr <br />T <br />17. Transporter I Acknowledgement of Receipt of Materials <br />R <br />A <br />Printed/Typed Name <br />Signature <br />Month y, <br />Yefir <br />N <br />S <br />p <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed Nome <br />Signature <br />Month Day <br />Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19. <br />I <br />T <br />Y <br />Printed/Typed Nome Signature <br />Month Day <br />Year <br />'89'1 <br />e, 1, <br />k, <br />GENERATWS CC" <br />