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__,d_ W. ' <br />Nfl. <br />a <br />- _ <br />y <br />NON -HAZARDOUS 1. Generator's US EPA ID No. Manifest <br />2. Page 1 <br />WASTE MANIFEST C, �. i. ' . '. •. ?. <� �. =/. !: �. <br />of <br />3. Generator's Name and Mailin Address <br />4. Generator's Phone (/) -V <br />5. TraPsporter 1 Company Name 6. US EPA ID Number <br />g4. <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />9. Designated FQjcility Name and Sit ddress - 10. US EPA ID Number <br />A. Transporter's Phone <br />- = ' <br />J/ 1 <br />B. Transporter's Phone <br />C. Facility's Phone <br />11. Waste Shipping Name and Description <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />No. Type <br />Ouanti <br />Wt/Vol <br />a. <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 />F-- <br />16. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest aro not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br />Printed/Typed Name <br />Signature Month Day <br />Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />R <br />A <br />Printed/Typed Name, i i <br />f <br />'' Month Da <br />Signature �� Y <br />Year <br />/ /L7 <br />0 <br />18. Transporter 2 4clinowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature Month Day <br />Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 19. <br />T <br />Y <br />Printed/Typed Name <br />Signature Month Day <br />Year <br />4 <br />�} <br />N■i'r'e2-4 BSS C5 r'Rev 1'1/83 + <br />.. .. sv.. �....2oH..L•til�u.a�s..Y9'TtlN >'.Y+r-_..�.s,3']ii. i�' <br />TY� YW i .iYwitt i., .. x ..rs4.'t..u.... <br />